US 2531734 A
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Description (OCR text may contain errors)
Nov. 28, 1950 H. H. HOPKINS 2,531,734
HIP NAIL AIMING DEVICE Fil'ed July 27, 1945 4 Sheets-Sheet l BY MMX/MW Nv. 28, 1950 H. H. HoPKlNs HIP NAIL Amma DEVICE 4 sheets-sheet 2 Filed July 27, 1945 Nov. 28, v1950 H. H. HoPKINs HIP NAIL. AIMING DEVICE 4 Sheets-Sheet 5 Filed .my 27. 19145 Nov. 28, 1950 l H. HJ'l-oPKlNs 2,531,734
HI? NAIL. AIMING DEVICE Filed July 27, 1945 4 sheets-sheet 4 (By Mm,
Patented Nov. 28, 1950` UNITED STATES PATENT OFFICE 2,531,734 HIP NAIL AIMrG DEVICE Heywood H. Hopkins, Rochester, N. Y. Applicationculy 27, 1945, serial No. 607,471
l.. Myinvention relates to a surgical device and method and more particularly to yadevice and method for the purpose of determining the direction or'angle at which a fixation nail `should be applied or extend inmaking internal fixations of inter-trochanteric and fractures of the femoral neck. While the device and method of my invention will be described for use in connection with the fixation of` fractures of the femur, the general principles `thereof may have application )inA the fixation of other bone fractures. When a fracture of the neck of the femur occurs, it is essential to the welfare of the patient that the fixation nail be applied in the proper direction or at the proper angle to be of `maximum effectiveness `in fixation of the fracture and not cause pain to the patient or result in a stiff joint.
Until comparatively recently it has been necessary, without using jluoroscopy,` to drill into the bone, locate a nailor ,pin inthe drilled opening, and then X-ray the Afracture with the nail or pin in position to determine whether the nail or pin was accurately located with respect to the fracture so that when the fixation nail was applied along this line, in" the opinion of the surgeon, maximum effectiveness in fixation would be secured. If the surgeon performing the operation made an improper estimate of the direction `which the drill line should take, the `incorrect estimate or the drill itself properly located and used as a guide, the fixation nail was driven into position at the saine angle to hold the fractured parts of the bone together.
More recently devices have been employed to reduce the possible necessity of making a number of drillings into the femur before theproper location or angle of the fixation `nail could be determined. However, insofar as I am aware, `these devices are cumbersome to operate and more than one drilling is frequently necessary before the proper location or directional angle for the'xation nail can be determined. i An object of `my `.invention is to provide a method whereby" the direction or angle whichlthe fixation nail should take in making fixations of the inter-trochanteric and neck fractures of the femur may be positively determined prior to drilling and solely by the use `of X-Hrays. y
f1' Another object fof my `invention is to provide a surgical device for use in determining the' direc 2 tion or angle at which the fixation nail for use in making fixations or fractures of the femur, should be applied without the necessity of making drillings into the femur prior to such determination.
f A further object of my invention is to provide improved means for retaining in the proper position adjacent to and on the shaft of the femur,
asurgical device for determining the direction or angle at which a fixation nail should be applied. My invention further contemplates the provision of a. surgical device, locating block or xture,`
tion of the fixture and by projecting the lines` formed by said locating element on said X-rays the proper direction or angle which the fixation nail should take can be determined solely from the X-rays.
Other objects and advantages of my invention will Abe set forth more particularly in the claims and will be apparent from the following description, when taken in connection with the accompanying drawings, in which:
Fig. 1 is a side elevation showing the head, neck and shaft of the femur and two typical fractures thereof, together with the surgical device, locating block or fixture of my invention;
, Fig. 2` is a Sectional view taken substantially onthe` line 22 of Fig. 1 in the direction indicated by the arrows; i
Fig. 3 is a view similar to Fig. 1 with the locating block or fixture shown in section and a drill in position inthe fixture;
Fig. 4 is a view taken substantially on the line V4--4 of Fig. 3 in the direction indicated by the arrows;
- Fig. `5 is a view of the locating block looking from the left side of Fig. 3;
Fig. 6 is a View of the locating block taken j Fig. 9 is a view showing the drill or pin in po-7 sitionA together with the `fixation nail for which the 'clrill or pin has served as a guide;
C Fig; `10 is a view of axation nail; l Fig. 11 is a sectional view taken substantially on the line II-Il of Fig. 10 in the direction indicated by the arrows;
Fig. l2 is yan end view of the xation nail;
Fig. 13 is a sectional View of a portion of the fixation nail;
Fig. 14 is an X-ray side elevation of the femur with the surgical device or fixture of my invention in position and illustrating -how the angle at which the fixation nail should be applied is determined; and
Fig. 15 is another X -ray View with the xture and locating element in the same position as in Fig. 14 and taken at an angle of approximately 90 degrees to the angle at which Fig. 14 is taken.
In the drawings (Fig. l) I have illustrated a portion of the iemur, generally indicated by the numeral i6, which comprises the head Il;A the neck I8, and the shaft i9. When fractures of the femur occur they usually occur either across the neck i8 or in the intertrochanteric area, the angle of such breaks being variable. In Fig. l, I have indicated two typical fractures of the femur.v t
HAssuming the fracture has been reduced, the legis heldin proper position, the' skin over the ai'ectedV thigh is prepared, and an incision is made from the great trochanter paralleling the shaft of the'femur down to the bone. The surgeon then drills'through the femur below the, greater trochanter through the neck and into the head of the femur.
As previously mentioned, the positioning of the drill-and the direction or angle at which it should be drilled islargely a guess under present nonfluoroscpic practices. After the drill position, "an X-ray. is taken to determine whether it isv properly located with respect to the `fracture so that, when a xation nail is positioned 'along thesame line, itsy direction will-bef such that it is 'properly locatedV with respect to the :cortical walls of the femoral neck to rse.cure,'in the opinion of the surgeon, maximum eiectivenessland greatest holding power. If the drill is not in proper position, another drill or nail or additional drill.-
ings of nailings must be done and additional J X-rays taken until the proper position or directional angle for the iixation` nail is'found. When the proper position orf the, nail or drill has been determined, the drillr is used as a guide during the driving into position of acannulated nail, i f
that most commonly usedk for this known as a Smith-Peterson nail.
The employment of the fixa-tion nail` locating device, block or iixture of my invention and the purpose being,
method of my invention, enables the determina- 3 tion ofthe proper direction or angle which the,
fixation nail should take and may/be accomplishedY entirely by X-rays. The device comprises a block or x'ture generally indicated by the numeral 2|, vwhich is made in two parts 242 and 23. The parts have planary surfaces 24 and 25 which are adapted to be mated together. A plurality of dowei pins 2s are provided to enable the proper locating of the two sections of the block with respect to each other after which a screw'r or. screws 2'! is used to fasten the two sections of thelocatingblock together. The purpose of'making the block in two sections is to facilitate manufacturing` and? to. enable Vmore thorough cleaning andstjerilization. Y f l The block 2! is provided with a plurality. of? bores .-or openings 2 8.- v'lIhese-bores or openings may at their entrance ends be arrangedxinany' desired pattern sothat a"locatingfpin `or drill 29 may assume, when' inthe various openings..
various angles with respect to the femur when the block or xture is located on and adjacent to the femoral shaft, as will be presently described. For example, the side of the block may be provided with notches 3| indicating rows of openings extending across the block. These notches indicate, as marked on the drawings, the angle of the bores or openings with respect to the axis of the shaft of the femur, for example, 20-30-45 and 55 degrees.
Three or'more rows of notches may be provided extending Ytransversely of the block so as to provide twelve or more possible positions of the locating pin 0r drill 29. It will be appreciated that the number of openings or bores used and the pattern of their arrangement is merely a matter of selection and convenience and any desired number of openings or bores may be used. However, it is essential that the openings be located in more than one vertical plane as I have indicated in Fig. 6, for example, planes I, 2, and 3.
The openings 28 areall drilled to a common apex or center 32. That is,A the openings diverge from acenter or apex 32 in more than one plane toward the outer face of the block. Thus, a drill or direction indicator inserted in any one. ofthe'vopenings will extend through the block to approximately the same position in or approximately in engagement with the femur, as shown in Fig; l. However, the direction indicator may be set at a different angle with respect to the femur depending upon` the opening into which it is inserted. While I havevshown a substantially solid block, it will be appreciated the central pertion of the block may be hollow as the apex 32 and the outer margins of the openings 28 determineV the positionv of the locating pin or the drill.u When the device is in position with respect to the femur and the pin 2 9 is in position for taking X-rays as will presently appear, the pin 2 fmay4 be consideredas astraight lineu portion ntledirection locator. N
The part 23 of the locating block is provided with a conical opening 3,3, the. apex of which is the cvoinnion'apex or center oi the bores 28;. This enables the' locating pinto be inserted inY any one, of the openings and extended throughV the' blockY so as to, protrude to the position shown in Fig. 1. The` forward face of the locating block 2 l is preferably vV-slhaped, as shown most clearly at '34 (Fig. 4), and the forward face isV provided with two o r more sharply pointed pins 36, the purpose of which` will presently appear. v
The block is` further provided with a cut out notch 3 1 into which thegend of the locating pin extends and with a notch 38. A 'Ihe'purposeot the notches 31 and 38 will be more clear upon reference to Figs. 14 and 15 which are intended to represent X-rays of the femur with the surgical device of my invention in position. It will be noted that the notch 3'5- shows up inA X-ray and enables the end of the locating pinordirec/.tionl indicator to be clearly seen (Fig. 1li). Upon an examination of Fig. 15, the notch 38'appears and enables the location of the centerline of the block and the line of the apex 3 2 to be determined. a
'Ijhe locating block or xture 2l is provided with a bore 4l having a, shoulder. 42 against which the cylindrical end of an adjusting screw 43 is adapted to seat. rIfhe screw is threaded as shown and provided with a knurled thumb piece dk4. --The adjusting screw is threaded into a UK-shapedI support or yoke 45 to each ofthe arms ot which, as shownat 4l, a lever 4,8 is pivotally secured, f The en ds ofthe lever 48 are prOVided., with gripping teeth 49 which are adapted to 4engage the bone, as shown infFig4, and support the locating block or fixture in position. The other ends of the levers 48 have threaded openings extending therethrough. The threaded openings 5l are adapted to receive respectively right and left hand threads formed on an adjusting element 52. A knurled thumb piece 53` is provided whereby rotation of the thumb piece in one direction closes the jaws of the lever arms and rotation in the opposite directionopens them.
` When the locating block or fixture is to be applied, after the soft parts around the leg have been properly prepared, the jaws of the fixture areengaged around the femoral shaft, as shown in Fig. 4, in the position desired. The thumb piece 53 is then rotated so as to clamp the fixture on the femoral shaft after which the thumb piece 44 is actuated to shift the locating block or xture forwardly or to the left, as viewed in Fig. 4. Shifting of the block causes the pins 36 to protrude slightly into the bone so as to be effective to aid in supporting the fixture accurately and rigidly in the position desired.
With the fixture inits proper position the de vice appears as shown in side elevation in Fig. 1.-
Thesurgeon then selects or estimates the angle at which a drill hole should be made 4in the bone properly to locate the fixation nail 4with respect into the cut out notch 3l, a side elevation X-ray 1' is taken which results in the X-ray picture shown in Fig. 14. From this X-ray it would appear that This pin is in the center 45 degree opening pin has also been indicated on Fig. by line `lill.
With the arrangement shown the surgeon may also estimate the depth to which` the drill hole should extend. He knows the length of the locating pin 29 and can measure the length of the pin as it appears on the X-ray,he may then k select the depth to which he should drill by xture, the amount of reduction or amplification in the Y-ray and again arriving at a proportion.
It will particularly be noted that no drilling ofthe femur is required to locate the direction or `angle at which the drill hole should extend4 through the femur.
Moreover, the fixture re-` mains in the same xed position throughout the determination of the` angle at which the drill hole should extend;` 'Ihis is important inreducf ing the possibility of error which might result if it were necessary to shift the block or fixture during the determination of the proper angle.
The entire determination may be made with the fixture in a xed position merely by extending the lines of the locating pin on two X-rays taken u l0 to 13, I have illustrated a Smith-Peterson nail the surgeon has properly estimated the angle at which the drill hole should extend through the bone because theextension of the locating pin, indicated by dot and dash lines in Fig. 14, ex-
tends approximately centrally in the femoral neck` which may be employed as a fixation nail. Such nails comprise three or more longitudinally extending fins 66 which are sharpened at their edges 67. sharpened as shown in Fig. 12, to enable the nail to be driven into the bone.
The nail is `provided with a longitudinally extending opening 68 which terminates in a threaded enlarged portion 69. The threaded portion is adapted to receive an extension strap (not shown) for supporting the nail `in position `by screwing the strap extension to the shaft of the femur. With the drill in the position shown in Fig. 3 and the block or fixture removed, the cannulated nail is slipped over the end of the drill in the plane of the paper of Fig. 14 or at apv (Fig. 6) of apertures that the contemplated drill` direction or angle is improper. That is, on Fig. 15 the direction of the `locating pin has ,been extended by dash line 5I and this dash line is oiset with respect to the center of the fracture, as will appear from Fig.l 15.
` The surgeon then is able to estimate` with reasonable accuracy that the drill opening should be made in alignment with the opening marked 45 degrees in longitudinal row three of apertures. This the surgeon may readily estimate from Fig. l5. However, if he so desires another X-ray may be taken with the locating pin in this position, which would result, when the line of the locating pin is extended, in the dot and dash line 62 of Fig. 15. The third possible position of the locatand the nail driven into position as illustrated in Fig. 9.
It will thus beapparent that I have provided a method and device for accurately determining the angle at which the fixation nail should be driven entirely by X-ray and without the possibility of errors which might be caused by the necessity of shifting the fixture during such determination. It will further be apparentthat various changes and modifications may be made in my method and device, particularly inthe form and relation of the parts of the fixture,` without departing from the spirit of my inven-V At their forward ends the :tins are 7 therefrom in more than; one plane toward the entranoeend-Y 2. Apparatus of the character described confiprioiria in. oombirreiioii, d Poil, airline; fixture, rrfrearis,y including a clamp for rigidly positioning the iixiure adiaeeei. o boire es required bv the location of the particularfracture being treated, ns for moving the xture toward and away from" the bone Without disturbing the clamp, said fixture having a plurality of openings extending therethrough', a locating element, each of said openings having an entrance end for the lo.- eating element and an exit end therefore, said exit ends terminating in a common exit and the,v openings diverging therefrom in a plurality of'planes toward the entrance end, said locatirie'elerrleni protruding from the iixidre et oooh enid so, that the line alone Whioh it iieS and its position relative to the fracture may be determirled by X-roys- 3. Apparatus of the character described for use in connection with fractures of the femoral bone comprising,A in combination, a fixture having aY plurality of openings therein, means including a pinfor use'in connection with said openingsO by'selective insertion in one of said openings for determining the angle at which a drill should extend into the bone for proper 'xation ofV the fracture, a support for said lixture, a clamp carried by said support adapted to extend about the bone, and means for adjusting the xturevvith respect to the support toward andv from the b one.
4. Apparatus of the character described for use in connection With fracture of the femoral bone comprising in combination a xture, means including a clamp for rigidly positioning the X- ture adjacent the bone as required by the location of,` the particular fracture being treated, means connected to the fixture for moving the xture toward and from the bone without distubing the clamp, said xture having a plurality of openings extending therethrough, a locating element, each of said openings having an entrance, end for the locating element and an exit end therefor, said exit ends terminating in a common exit and the openings diverging therefrom in a plurality of planes toward the entrance ends, said locating element protruding at the xture at each end so that the line along which it lies and its position relative to the fracture may be determined by X-rays.
In the locating of the position which a hip fixation nail should occupy to retain the parts of a femury fracture together while they unite or heal, the method which comprises. positioning a direction locator with the direction locator being located on the femur bone with all its parts` externally of the bone in its entirety and at the approximate point which the nai-l should enter,v
X-'rayi-ng the fractured bone. and; the direction` 6. In the locating of the position which a hip @ratios ,oeil ohouid oooopy tov retain iliotorio parte, of o femur fracture' together While.. thal unite or heal, they method which comprises pof-I sitioning a straight line direction lodator with the direotior1 locator beine; .looated on the femur bone with all of its parts externally of the bone in. its entirety and at the approximate point which the nail Should enter, Xfroying the .free-ftured bone and the direction locator in two planes. which are approximately at right ongles. withy respect to each other while retaining thev direction locator in a fixed position, and deter, mining from. the projections of the lines formed on said X-,rays by ,Saidr direction locator the line along whioh the. neil should lie .order to. be pq- Sitioned properly ooA desired by the surgeon, with. respect tov the fracturaI drilling along Saidy line, and driving the. mail along said drill line.
7. Iri the ioooiiris of the position which o hip xation nail eh uid, ooeupv to .retain the bone parte. together While they unite. or heal. a freeiore. of ishe ierriorol noch the I nethod which oomprises Securing o direetioii loootor Wholov includes d. Straight line portion, to the iemordl neck with all of its parts externally of the bone and at4 the approximate point which the nail should enter, X-raying thel fractured bone and the direction locator including the straight line portion in two planes which are approximately at right angles to each other while the direction locator is maintained in a fixed position, determining from the projections of the ilnes formed on said X-rays by said straight line portion of the direction locator the line along which the nail should lie in orderthat the nail shall have maximum hold-ing power, drillingy along said linewhile employing` the direction locator as a guide and While the direction locator is maintained in a xed position, and driving the xation nail along said drill line.
HEYWOOD. H. HOPKINS'.
REFERENCES CITED The following references are of record in the 'le of this patent:
UNITED STATES PATENTS OTHER REFERENCES