US 2614558 A
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patented a. 21', 1952 r 'raaornan surron'rmo DEVICE E dgarSherburne Lovell, Brattleboro, Vt, j Application April'i, 1950, Serial No. 153,381
This invention comprises 'a new and'imp'roved fracture 'supporting device for use in supporting the arm of a patient suffering from skeletal fracture while the latter is beingimmobilized by the application of a bandage, cast, or splint. While the device of my invention'is particularly useful in dealing with a 'Colles wristiracture, it is useful in part in any case'where the forearmis to'be maintained under traction in "setting bones and applying splints and the like. H Going moreinto detail, my improved support ing device comprises a'main bracket adapted to be clamped to an operating table! or any table upon which a patient might be placed, and ineluding a rest for the forearm *acljustably mounted in a substantially horizontal position,
and an upper arm rest adjustably mounted in substantially vertical position and at such. an angle to the general direction of the. forearm rest that it will effectively resist traction applied to the forearm. Preferably and as herein shown, the forearm rest is'upwardly concaved or trough-shaped and of such length as to underlie substantially the full length of the :patients forearm, yet permitting the hand and wrist to be flexed downwardly and the wrist conveniently exposed for the-surgeons work or X-ray work upon it. The upper arm rest is also preferably concave so as to .fit comfortably the contour of the upper arm as .it extends at is portable and may be clamped to thetable,
for example, in any desired or convenient location-and upon either side of the table so that it is adapted to support eitherthe right or left arm of a patient. i
The forearm rest is mounted for substantially universal adjustment, that is to say, for height, for in and out horizontal adjustment, and for angular adjustment both vertically and horizontallyt The upper arm rest may also be adjusted for height and angle and in its relation to the forearm-rest. These and other features of the invention will be best understood and appreciated from the following description of agpreferred embodiment thereof, selected for purposes of illustration and shown in the accompanying drawings in which: Fig. 1 is a view in perspectiveof the complete device showing a section of the operating table to which it is clamped and indicating in dotted lines the arm of a'patient, and Fig. .2 isa cross-sectional view through the upper .arm supportand its clamping connec tions.
,zoiam isr v (01.1284 7) r, l 2" Q 1 In Fig. l is, shown aiportionoi one of thes-ide rails Ill of anoperating. table, and while this is "represented as circular in cross-section, it
of theblock uponthe arm.
may well; be of any other shape. The;main
bracket H of the device is channel shaped, pre--v g senting an open side-designed to embracethe side rail it] and providedwith clamping-screws r I2 by which it. may be securely fixed in place.
.The main bracket I l is providedvwith a vertical clamping, section" l3 anda clamping screw i l. Betweenthe section 13 and the main bod-y of the bracket-is formed a vertical bore inlwhich is' adiustablyfitted a vertical spindle" H5; The spindle may beadjusted as to heightand rotary position by loosening the clamping screw; I4 and then secured in the desired position bytightene inggthe same, The spindle l5 carries a horizontal arm it upon which is adjustably mounted asplit clamping block ll-gprovided;witha hori V 'zontal' bore for the arm 5'6 andag clamping screw 1E8 'which permits both in and out' adjustment The lock I?! also has-a vertical, bore in which is ad-justably fitted avertical rod'l9. The latter may be'adjusted vertically and angularly in the block and clamped in the desiredposition: by a horizontal clamping; screw-29. The upper end of the rod, I9 is bent to providena-horizontal vjournal and this I is received in a:- split bracket. 22 provided with a clamping screw 23. The, bracket 22 is formed as'a: part of the forearm rest El-which extends toward the right fromits journal bearing and is upwardly concave to it comfortably theflpatients forearm., It will be seen that in addition to the various "adjustments above enumer ated,-;the, rest 2 l' maybe tilted if desired" about itsp horizontalfjournal and clamped in the desired positionlbythe clamping screw/'23. The
bracket 22 is secured to one end oithe forearm rest 2! and the free end of the rest projects into unobstructed-space so that a patientswrist may be flexed over it as-suggestecl in FigJ-l;
The upper arm rest ,24 has a concavefa'ce directed away from the iree end of'the fore-1 arm rest and ispr'o'Vided-With a pad or cushion 25. of felt or the like 'and' is secured to a conl cave plate 26 which is fitted to its outer con veic surface as best shown inFig. 2"; The-body of the rest 24 is slotted to'receivea clamping bolt zs having an enlargedhead which lies i within 'theslot. Asplit clamping block 21 is slidably fitted upon the spindle l5 and provided with a lhorizo ntal borevfor theclarhpiri'g'bOlt 28. The latteris provided at its' outer end with a. clamping nut29. The clamping bolt 28 is slotted within the split block 21 to receive a dowel pin 30 which projects through the block 2? and serves to prevent displacement of the block on the bolt 28 when the clamping nut 29 is released. It will be seen that by loosening the nut 29 the upper arm rest may be adjusted for height and angle in a horizontal plane about the axis of the spindle lb. The rest may also be adjusted as ,to angle in avertical plane by reason of its slotted connection withthe clamping bolt 23 and this adjustment, it will be observed, takes place about the center of curvatur of the rest 24 itself.
In using the device above described, the device as a whole is clamped-in position upon the rail In and then the two rests are adjusted to suit the convenience of the surgeon and the comfort of the patient. Such position is indicated in 'Fig. 1 by the dotted line representation of the patients arm, from which it will be apparent that the flexed wrist is presented advantageously to the surgeonwhile the arm of the patient is fully supported and therefore relaxed and that forward traction upon the forearm is effectively resisted by the upper arm rest 24.
The horizontal arm [6 is flattened on its under side and the borein the clamping block I! through which it passes is similarly shaped so that the block I1 and the parts carried thereby are positively held against twisting on the arm It. It will be noted that the horizontaljournal formed bythe upper end of the vertical rod I9 is of substantially the same length as the thickness of the bracket 22, with the result that when the-clamping screw 23 is loosened the bracket 22 with the rest 2| may be readily slipped ofi from this journal, the rest 2| being thus readily detachable from its support.
In actual use of this fracture device, its advantages over other methods. of treatment of Colles fracture are immediately apparent. The patient is placed supine on an operating table, or any tablelto'whioh thedevice may be fitted, and preparations are made for anesthesia. During this periodthe device is so placed that the patients upper arm, when abducted to 90, properly engages, with regard to height and angle, the padded upright portion of the frame. With the 'elbow clearing freely the outermost portion of the padded upright, the forearm rest is so adjustedbothasto angle and distance from the main uprightspindle that the forearm rests comfortably on the rough-shaped rest so that justments have been made, the patient is, anesthetized.
With theupper arm resting snugly against the; padded upright. for counter-traction, steady traction is then appliedto the hand and wrist by the operator and the fracture, is reduced. During this portion of the rocedurethe forearm usually is, suspended over the horizontal forearm rest; When the manipulationhasbeen completed, theforearm is then lowered upon this rest, and with traction stillbeing maintained by the operator, the. exact position of the hand and wristisumaintained, and anteroposterior and lateral Xrrays may be taken.
When the position of the fragments is satisfactory to the surgeon, hethen turns.the..-maintenance of the;.'trac,tion.over toan assistant who stands along1.de;..the table, and, exertsgentlc 4 traction in a predetermined position by holding on to the patients thumb with one hand and the patients fingers with the other. No other assistance is necessary and the surgeon is then free to apply plaster, or whatever form of immobilization he may choose, to the extremity.
This may be applied directly to the extremity, including the rest 2| itself, back to the point where the latter receives its support from the small upright rod l9. This will take the immobilization well back to the elbow, which is ordinarily sufficient immobilization for a wrist fracture. The extremity is maintained in this position until the plaster or other immobilization has set. The forearm supporting rest is then detached from its supporting upright rod |9 by loosening the locking screw 23 and sliding the bracket 2'2 about 2 cm. laterally off the horizontal end portion of the rod. The rest is then detached from the immobilizing medium by simply withdrawing it from beneath the latter in the axis of the forearm. Should the operator wish to continue the immobilization of this fracture to a point above the elbow, he may then do so at this juncture.
The frame finds additional use in the treatment of both bones of the forearm by providing a means of counter traction against the padded upper arm rest 24. The forearm rest is of little use in this connection, and, under thesecircumstances, may be entirely detached if desired. After reduction of the fracture, traction and counter traction may be maintained while some form of immobilization could be applied.
The obvious advantages of this device herein shown in the treatment of wrist fractures are as follows:
1. A means of counter traction is provided at all times, which doesnct require the presence of an assistant.
2. Once the fracture has been reduced, provision is made for the maintenance of accurate reduction by the continued support of the forearm.
3. X-rays may be taken at the time of reductionv with assurance that the position of the fragments following application of some means of immobilization will be maintained as of the completion of immobilization.
4; After reduction has been secured, the'presence of one untrained assistant to hold the hand in a predetermined position leaves the surgeon completely free to apply the means of immobilization, knowing: that the reduction will bemaintained throughout this'portion of the procedure.
Having thus disclosed my' invention and described in detail an illustrative embodiment thereof, I claim as new and desire to secure by Letters Patent:
l. A fracture supporting device comprising a bracket having an opening for the reception of the rail of a hospital table, clamping means, an upright spindle rising from the bracket, a horizontally disposed forearm rest carried by the spindle and having a free end projecting into unobstructedspace, an upper arm rest mounted on the spindle independently of the forearm rest and at a level above the latter and having a curvedfacedirected away from the free end of the forearm rest, the-mounting of the upperarm rest including a curved plate and a clamping bolt whereby the upper arm rest maybe adjusted above the center of'itsradius of curvature" to locate'it for resisting tract-ion applied to the-forearm. 7
' 2. A fracture support comprising a main vbracket adapted to be clamped to an operating table and having a vertical bore, a spindle adjustably mounted therein, a horizontal arm projecting from the spindle, a trough-shaped forearm rest adjustably mounted thereon and having a free end projecting into space, an upper arm rest mounted independently and adjustably on the spindle above the horizontal arm and presenting a substantially vertical concave face directed away from the free end of the forearm rest for resisting traction applied to the forearm.
' E. SHERBURNE LOVELL.
6 REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS Number Number Name Date Schwarting Nov. 25, 1924 Goodhart May 31, 1938 Stearns May 27, 1941 FOREIGN PATENTS Country Date Germany June 30, 1925