US 2590532 A
Description (OCR text may contain errors)
- March 25, 1952 E. J. HABousH 2,590,532 DEVICE FOR BENDING FRACTURE NAILS AND THE LIKE FOR IMPACTING FRACTURES AND EXTRACTING SUCH NAILS Filed NOV. 30, 1949 2 SHEETS--SFEET HIS ATTORNEYS.
March 25, 1952' 2,590,532
G FRACTURE NAILS AND THE LIKE F0 S L .I A N H C U S G N n w m u m. H m D N H A m w E m M I A D R N F E B G m T C E A w II V E D 2 SHEETS-Si-EET 2 Filed Nov. 30, 1949 unk g 22 Fall??? INVENTOR.
EDWARD J. HABOUSH f BY (I M 'W.:FAMY
Patented Mar. 25, 1952 UNITED STATES PATENT OFFICE DEVICE FOR BENDING FRACTURE NAILS AND THE LIKE FOR IlHPACTING FRAC- TURES AND EXTRACTING SUCH NAILS Claims.
This invention relates to surgical instruments and it relates particularly to instruments for bending, inserting and removing nails and bone plates used for the reduction and fixation of fractures, especially fractures of the hip.
In reduction of fractures of the hip, as Well as other fractures, it has become rather common practice to reinforce and fix the fracture by means of bone nails or pins, bone plates or combined nails and plates which are driven into the bone fragments and/or secured to them to span the fracture to fix the fragments relative to each other so that they may knit together. In many cases, the use of these artificial reinforcing elements permits the use of the fractured member while the fracture is knitting or healing.
When combined nails and bone plates are used for the fixation of fractures atthe neck of the femur, one end of the nail and bone plate is driven into the fragments so that it spans the fracture with the end of the nail embedded in the ball of the femur. The remainder of the nail and bone plate is bent down and fastened to the shaft of the femur by means of screws to form a strong and rigid connection across the neck of the femur.
One of the difficulties encountered in this type of fracture fixation is the bending of the nail and bone plate to the proper angle so that the projecting portion of the plate lies parallel with the shaft of the femur.
Nail and bone plates must be strong and relatively rigid so that motion between the bone fragments is prevented, even when the patient is permitted use of the fractured member. Because of this rigidity, it is most diflicult to bend the plate to the desired angle with the instruments now available. Especially it is not possi ble to do this when the nail, and plate has been driven into the bone and is in the best position to determine the angle to which the protruding portion of the nail and plate must be bent to render it parallel to the bone. Therefore, it is customary to bend the plate or nail prior to driving it into the bone. Such bending produces, at best, only an approximation of the correct angle. Moreover, the bent condition of the nail makes it difficult to drive and guide the nail accurately into the bone.
The present invention provides an instrument which overcomes the disadvantages of prior nail bending devices, and makes possible easy and accurate bending of such bone nails and plates.
A typical embodiment of the invention may include a pair of relatively movable anvil members which support a nail or nail plate in contact with a fulcrum member closely adjacent to the bone. The anvil members are first moved into alignment to engage a straight nail or plate and then are moved relatively to bend the nail around predetermined angle.
The device is provided with power multiplying means so that while it is compact and convenient to manipulate, sufiicient power may be developed at the anvils to bend the most rigid types of nails and plates available.
Moreover, the instrument may include an impactor for seating the bone fragments and this impactor may be used in conjunction with the bending elements to drive the nail into the bone and to withdraw the nail from the bone if it is inserted improperly or too deeply.
For a better understanding of the present invention, reference may be had to the accompanying drawings, in which:
Fig. 1 is a view in side elevation of a typical bending and impacting instrument embodying the present invention;
Fig. 2 is a bottom plan view of the instrument shown in Fig. 1;
Fig. 3 is a view in elevation of the head of the instrument which is partly broken away to disclose details thereof;
Fig. 4 is a view in section taken on line 4-4 of Fig. 2;
Fig. 5 is a view partially in side elevation and partially in section and of a part of the instrument broken away showing an adjusted position thereof; and
Fig. 6 is a view in section of a detail of the instrument illustrating a different relation of the parts thereof.
The instrument chosen for purposes of illustration is constructed for use with combined nails, nail plates and nail and bone plates of the type disclosed in my copending application Serial No. 782,503, filed October 28, 1947, and now Patent No. 2,496,126. Nails and nail bone plates of the type disclosed in the application will be referred to hereinafter as nails for brevity. These nails are generally I-shaped in cross-section.
The instrument is designed to accommodate the flanges on the I-shaped section, but it will be understood that the device can be modified to receive and bend other types of nails and plates than the nails disclosed in the abovementioned application.
As best shown in Figs. 1 and 2, the nail bend- 5 nected to the right-hand end of a the handle I0, as viewed in Fig. 1 and project outwardly therefrom at an acute angle to the axis of the handle. The fulcrum pin I3 is mounted in the ends of the arms I4 and I5 by means of a pair. of externally threaded sleeves I6 and. H which" arescrewed into thearms I4- and I5- and have non-threaded end portions I8- which projectbeyond the innersurfaces of the arms; for
example; the arm I4, asshown in Fig. 3, to forma' bearing or hearing sleeve for supporting the anvil members II and- I2; aswill be described. Each of the sleevemembers I6 and I! also is internally threaded for a portion of its' length to-receivethe threaded enlargement I9 on the fulcrum pin I3. The inner ends ofthe sleeves I6 and I1 are smooth and serve-as bushingsfor receiving the reducedportion of the pin I3-. The pin- I3 may also be provided with an enlarged head 20" and a cross pin 2I- to facilitate its rotation to insert it and remove it from-the sleeves I6 or IT. The pin I3- can be inserted through either of the sleeves I6 and I1 as may be desired and depending upon theconvenience to the operator;
' The sleeves Iii-and I-I support a U-shaped member 22 whiclihas its base formed by the anvil member I'l The ar'msg24 and 25 f" the U SIiaped member 22- on the oppositeside of the pivot-pin I-3' from the anvil I12 are-inclined at an obtuse angle to a line extendingthrough the axis-of the pivot I3=normal to the; adjacent face of'the-anvil' I2;
of a: toggle system by means -of which the anvil member I2 can be rocked aroundthefulcrum' pm I3. The other arm of thetoggle'co'nsists of a: =-shaped member- 26iliaving sp aced' apart arms 21 and 28 connected by means of pivot screws 29--and 30 to=the-ends of the: arms 24and25; re-
spectively. The opposite end of the Y-shaped linls 26 is connected between. a pairoflugs-3| and? 3.2 extending from atubular internally threaded. sleeve member 33 which'is slidable axially within the handle Ill. The lugs illan'd 321fei'rter'idz' through a guide slot" I 0a extending lengthwise of the handle If]; Y
Upon sliding movement of the sleeve 33' to the rig-lit, asviewed' in -Figs. 4'- and the anvil member I2? isrocked counterclockwise around the: pivot and upon sliding movement of the. sleeve; 33-tozthe-1left'-,. the anvil member I2. is
rocked clockwise around the; pivot. Sliding,
movement .of' the sleeve isproduced. by, means.
of. an externally threadedtubular member 34. mounted within. the handle. I Ilandthreaded into.
the sleeve 33;
Asbest shown. inEig. 4, the tubularmember S'Hias at its l'ef-t-handiend. anreduced unthreadedtubular. portion.-v 35=which is rotatable. in the opening 36 in the left-hand end of the handle (Figs.- 4; 5'- and 6.) The arms 24 and 25 of the member-22form one-arm- I0 formed by the inturned ,fiange 31. The member 34 has an enlarged collar 38 which bears against the flange 31 and limits movement of the member 34 to the left.
Movement of the threaded member 34 to the right is prevented by means of the operating handle 33 including a disc-like portion 46 having an internal circular recess M for receiving the left-hand end of the handle III. The handle 39 has an internal bore 42 receiving the sleeve portion and is secured thereto against relative. rotation by means of a suitable key 43 or its equivalent. The handle 39 is retained in position by means of a lock nut 44 threaded on the-outer end of the'sleeve portion 35 and abutting the tubular extension 45 on the handle 39.
To facilitate rotation of the handle 39, it may be provided with outwardly extending rods 45 and 41 (Figs. 1 and 3) by means of which more power-can-beapplied to the-tubular member 34.
Inasmuch as the-handle-39-abuts the end of the handle I6, rotation of thehandle 39 relative to the handle- IIl will cause the sleeve 33 to move.
lengthwise-of the handle- I0,- thereby rocking theanvil member I2 as described above.
As'best shownin Fig. 2, the surface 23 of the anvil member 12 is provided-with a pair of spaced apart grooves 48- and-49- defined by spaced apart ribs 50 and 5I substantially fitting the cross-sectional shapeof thenail-N to holdit against lateral sliding movement.
The anvil II is provided with similar aligned groovesand' ribs so that it can engage a portion of-thenail adjacent to that supported by the anvil I2- when the anvil members II and I2 are in alignment, as shown inFigs. land 6.
The'anvil member- II is also supported on the bearing sleeves I8 ofthe members I6 and I1 for rocking movement relative to the arms I4'and I5. As best shown in Figs. 3 and 6, the anvil member II is supported on the sides of a pair of spaced arms 53 and 54 disposed between the arms 24 and 25 of the U-shaped member 22.
Above and behind the grooved surface of the anvil member II is an arcuate surface formed with ratchet teeth' 55 by means of which the angular position of the anvil member around the fulcrum pin I3 can be controlled. The anvil member I I is held in adjusted position by means of a pawl member 56 having a pawl tooth 5I and a hollow'cylindrical barrel portion'58 fixed toa cross' pin 59 which is rotatably mounted in "apertures in the arms I4 and I5. Theend of the cross pin.59"is bent laterally and is flattened to form an actuating ,lever 60,by means of which the pawl member. 56 can be rocked to disengage the pawl tooth 5! from" the ratchet 55. The ratchet 55 and the anvilQmember; I I are normally urged clockwise as'.viewe.d in Figs.14. 5 .andifi. by: means ofa looped spring 6| having one" end; 62'
bent laterally and engaging. in a holein' the. side of the anvil member I I.
towardthe. ratchet 55. In thisway, the pawl andtheratchet are always urged towardeach other so as to retain the anvil member. .I I against.
rotation in-. a. clockwise direction. unlessthe .pawl
isretracted, whereupon .the anvil member. It will. swing into. engagementlwith thelside. of. thevanvil Its opposite end is bent. aroundthebarrel 58.of thepawl and engages in. an aperture therein to normally urge the pawl nism affords accurate control of the extent of bending of the nail.
The anvil member [2 is limited in its angular displacement by the extent of movement of the sleeve 33 relative to the handle it so that the total movement of the anvil member l2 in a typical instrument will be in the neighborhood of 60. Therefore, if the anvil member [2 is rocked in a counterclockwise direction to its limit of movement and the anvil member ll isaligned with it so that the nail N is in fiat engagement with the surfaces of both of the anvil members, the nail can be bent to a 60 angle by rotating the handle 39 to cause the sleeve33 to move to its limit of travel, as shown in Fig. 5. Assuming that the pawl 57 engages the uppermost tooth of the ratchet 55 when the anvil I2 is in alignmentwith the anvil H, the nail will be bent by movement of the anvil member l2 through an angle of 60. For less'er angles, the pawl member 56 is released so that the anvil member H can swing around in a clockwise direction to permit one of its lower teeth to engage the pawl 56 when the latter is released. By suitably spacing the teeth of the ratchet 55 and providing a scale S (Fig. 1) on the face of the anvil member II, it is possible to bend the nail N through any of a series of angles of predetermined values.
The anvil member II is adjustable to increase the angularity of bending by rotating the handle 39 insuch a direction as to bring the anvil l2 up against the anvil I I, as shown in Fig. 4, and continuing the rotation in a direction to further collapse the toggle so that the anvil member II is rocked against the action of the spring 6| in a counterclockwise direction to engage the pawl 55 with successively higher teeth on the ratchet, as
shown in Fig. 6.
In use, the anvils H and l2 may be adjusted to approximately the desired angle to which the nail is to be bent by reference to the scale S. The handle 39 then is turned to grip the nail firmly between the anvil members H and I2 and the fulcrum pin 13. With the nail gripped tightly, the instrument can be used to drive the nail into the bone fragments across the fracture to a .point where the end of the instrument is substantially in contact with the shaft of the bone to which the protruding end of the nail is to be fixed by means of screws and the like. The handle 39 is then rotated further, bending the nail over the fulcrum l8, as shown in Fig. 5, until the projecting portion of the nail lies parallel with the bone fragment to which it is to be secured.
The handle 39 is then rotated in the opposite direction to relieve the bending pressure on the nail and the fulcrum pin [3 can then be unscrewed and pulled out of the supporting sleeves l6 and [1, thereby leaving the nail in a position spanning the fracture. The nail can then be driven in fully until the downwardly bent portion thereof lies against the fragment of the bone to which it is to be fixed.
The ability of the device to be used in driving the nail and bending the nail after it has been partially driven into position is a great advantage for it makes possible the proper alignment of the relatively bent portions of the nail with the axis of the fractured bone and the outside of one of the bone fragments. The device can, of course, be used for bending nails prior to insertion, and after bending them, it may be used to drive the nail almost completely into the bone to span the fracture.
The instrument is also provided with means for impacting fractures and for withdrawing nails which are not inserted properly or accurate- 1y. The impacting mechanism may consist of a hammer 65 which consists of a cup-like member 66 having a block of rubber 61 or the like mounted therein and projecting beyond the cup and having a shaft portion 68 which is fixed in the end of an internally threaded tube 69. A bearing sleeve 10 ,is fixed in the right-hand end of the handle In to receive the member 69 and guide it for sliding movement axially of the handle Ill. The guide sleeve 10 is provided with a spline H which engages in a groove 12 in the exterior of the sleeve 69 to prevent rotation of the sleeve.
The sleeve 69 is moved axially by means of a screw threaded shaft 13 having an operating knob 14 threaded on its outer end and a collar 15 pinned to it which has a sliding fit in the sleeve portion 35 on the screw member 34. The collar 15 is spaced from the knob 14 so that the threaded shaft 13 is capable of limited axial movement relative to the handle In. This limited movement permits the knob 14 to be retracted and then struck to cause the endwise movement of the hammer 65' to permit impacting and proper seating of the bone fragments. Also, rotation of the knob 14 will project the rubber block 61 against the fractured member so that if the nail is gripped between the fulcrum pin 13 and the anvil members H and I2, sufiicient pressure can be exerted to withdraw the nail partially or completely from the bone fragments.
By rotating the knob 14 in the opposite direction, the hammer block 51 can be completely retracted within the end of the handle I0 and the knob 14 drawn up tightly against the left end of the nut 44 so as to form a fixed abutment which can be struck by the hand or with a mallet to drive the nail into the bone fragment.
It will be understood that the apparatus described above will be formed of materials such as to render the device capable of sterilization without corrosion. Such materials may be stainless steel, Monel and other oxidation and acidresisting materials. It will be understood further that the instrument may be made of a'suitable size to accommodate the specific type of nail required for the operation and that other changes may be made in the device, depending upon requirements, without departing from the invention. Accordingly, the form of the invention described herein should be considered as illustrative and not as limiting the scope of the following claims.
1. An instrument for bending bone nails and the like comprising a handle member, a pair of spaced apart arms extending obliquely from one end of said handle member, a fulcrum pin detachably mounted in and extending between said arms, a pair of anvil members mounted between said arms for angular movement about the axis of said pin, said anvil members being spaced from said pin, pawl and ratchet elements on said handle member and one of said anvil members to releasably retain said one anvil member against movement in one direction and allow angular adjustment of said one anvil member in either angular direction, a toggle mechanism connected to the other anvil member, and means carried by and rotatable relative to said handle member to collapse and straighten said toggle mechanism and move said; other anvilmember angularly' around said fulcrum pin.
2. An instrument for bending. bonenails and the like comprising a handle member, a pair of spaced apartarms extending obliquely from one end of said handle member, a fulcrum pinde: tachably mounted in and extending between said arms, a pair of anvil members mounted between said arms for angular movement about the axis of said pin, said anvil members being spaced from said pin, means to releasably retain one-of said anvil members against angular movement in one direction, a toggle mechanism connected to the other anvil member, a member connected to said toggle mechanism and slidable relative to said handle member to collapse and straighten the'latter, an actuating member rotatably mounted in said handle member and having a handle thereon for rotating it, and means connecting said actuating member to said slidable member to slide the latter upon rotation of said actuating member.
3. An instrument for bending bone nails and the like comprising a hollow hand1e member, a pair of spaced apart substantially parallel arms at one end of said handle member and extending obliquely therefrom, a pair of bearing sleeves mounted in said arms and extending inwardly therefrom in axial alignment, a fulcrum pin detachably supported in said sleeves, a pair of anvil members pivotally mounted on said bearing sleeves in spaced relation thereto for relative angular movement into and out of alignment with each other, and means on said handle member for moving said anvil members relatively to bend a nail between them and said fulcrum pin around said fulcrum pin.
4; An instrument for bending bone nails and the like comprising a hollowhandle member, a pair of spaced apart substantially parallel arms at one end of said handle member and extending obliquely therefrom, a pair of bearing sleeves mounted in said arms and extending inwardly therefrom in axial alignment, a fulcrum pin detachably supported in said sleeves, a pair of anvil members pivotally mounted on said bearing sleeves in spaced relation thereto for relative angular movement into and out of alignment with each other, means on said handle member for moving said anvil members relatively to bend a nail between them and said fulcrum pin around said fulcrum pin, an elongated threaded member non-rotatably mounted'in said handle mem- I her and movable axially thereon, an impacting;
head on one end of said threadedmembenadr jacent to said arms, and another elongated threaded member rotatably and axially movable in said handle member, said threaded. members; being in threaded engagement and relatively, to.- tatable tov project said impacting head, beyond said arms andsaid fulcrumrpin and toretract;
said impacting head into said handle member.
5. An instrument, for bending bone nailsv and.
the like comprising. ahollow handle membena.
pair of spaced apart substantially parallel arms;
at one end of. said handle member andextending obliquely therefrom, a fulcrum pindetachably supported in said arms,.a pairofanvilmembers pivotally. mounted on saidarms in spaced relation;
to said fulcrum pin for. relative angular move-:-
ment into and out of alignment witheach other,
EDWARD J HABOUSH'.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS Number Name Date 896,207 Hazen Aug; .18; .1908. 1,403,589 Cinquini Jan. 17,1922. 1,879,868 Breer Sept; 27,1932; 1,889,239 Crowley Nov. 29,1932; 1,935,055 Morgan Nov; 14;.1933 2,127,185 Parker Aug. 16,1938? 2,312,947 Westman Mar. 2, 1943. 2,341,489 Tornborg Feb. 8; 194A;
FOREIGN PATENTS Number Country Date;
361,592 Germany Oct. 16,1922.-