US 2631584 A
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March 17, 1953 A. T. PURIFICATO FRACTURE SECURING INSTRUMENT 2 SHEETS-SHEET 1 Filed July 22, 1948 /7L FRED 7T PUP/Flam,
March 17, 1953 A. T. PURIFICATO 2,631,584
FRACTURE SECURING INSTRUMENT Filed July 22, 1948 2 SHEETS-SHEET 2 Il'iilll rllliiiil. rililllil Patented Mar. 17, 1953 UNITED STATES rem" OFFICE 16 Claims.
This invention relates to improvements in fracture securing instruments, adapted especially for securing bone fractures by the insertion of a nail therein, or for removal of the nail therefrom.
Various attempts have been proposed heretofore to secure fractured bones, usually by nails or screws, but these generally have not been satisfactory for various reasons. In fractured hips, especially when the fracture in the continuity of bone occurs in the neck close to the head portion, Smith Peterson nails, Lorenzo screws and multiple long screws fail to maintain reduction. The head fragment is so small and the structure of the bone through which these instruments pass is so soft that disengagement usually occurs. Most operators will not attempt nailing in such cases. Since most cases of this type of fracture occur in elderly individuals complications due to stasis are common and too frequently terminal. If they survive they live in continuous pain. The affected limb is shortened as a result of disengagement and absorption of the fragments.
The object of this invention is to eliminate the objections to nails and screws as proposed heretofore, some of which have been mentioned above, and to improve the construction of a fracture nail and an instrument for inserting and removing the same whereby the fracture may be secured efiectively and with little pain and suffer,- ing as compared with that encountered heretofore.
This instrument is so devised and constructed that when properly used it will not only hold two fragments in apposition but will also impact .them, making rotation and separation of fragment impossible. When the internal portion of the nail or pin is forced into the bone frag- ,ment its curved tip exerts both a wedge and grip action. This gives the operator full control of all. of the movements of the fragment. The nail :proper still offers all the advantages of the various types of nails and screws now in use. .-.The hook like action of the inner pin coupled with the function of the nail proper grips one fragment and keeps both fragments in alignment. ,The nail itself is fitted with a cap that can be .tightened at will and to an extreme degree. When the cap is tightened the entire instrument, nail and projection curve pin, produces a vise-like action causing impaction of the bone fragments. .As long as the cap remains set the impaction cannot be disturbed.
a Proper introduction of the instrument under discussion allows the internal pin to be arched daterally beyond the limits of the central caneither proved best for plain steel.
cellous bone and to become imbedded in the firm structure of the subcortex and the inner layers of the cortex proper. The internal pin in its laterally curved course toward the circumference of the head reaches a point beyond the circumference of the neck, thereby interposing hard bone between the hooked end of the pin and the cap. The impacting action of the screw-cap completes the process of obtaining fixed impaction.
A nail that encounters a knot at a point some distance beneath the surface of wood in the process of being driven will deflect its course or will bend. This, providing the deflecting angle is not too acute. If so, it will bend at a point of least resistance above the knot. The casing of the nail and the increase in diameter of the driver and extractor rod offers more resistance to the internal pin than that offered at the incline plane of the foramen. Therefore it will there change its course.
Since steel, stainless steel, SMO, vitallium, etc. possess malleability and flexibility or bending and retaining properties within certain degrees, the course of the pin will change providing the angle is not too acute. The more obtuse the angle, the
easier it will bend while the opposite is also true until impaction or breaking occurs. However, by experimenting with stainless steel and SMO, an angle of 50 proved satisfactory when the diameter of the pin was while 45 and as Other factors such as heat treated metals must also be considered. The driver and extractor rod in its use undergoes the greatest amount of strain in this apparatus in the process of extracting the internal pin; therefore in its construction, hard heat treated metal should be used. The material used in mak-' ing the internal pin must be of good quality and flawless, and should possess no irritating properties to harm the tissues in which it is placed. SMO, vitallium, etc. are examples. The same is true of the nail proper and its cap. Suitable material for construction of the remaining articles is a good quality of stainless steel.
One embodiment of the invention is illustrated in the accompanying drawings in which:
Fig. 4 is a longitudinal sectional view through the nail, showing the pin in elevation;
Fig. 5 is a longitudinal sectional view, showing the nail and pin insertion instrument;
Fig. 6 is a similar View, showing the pin extraction instrument; and
Fig. 7 is a similar view, showing the nail extraction instrument.
The fracture nail is shown generally in Figs. 3 and 4 and has a body designated by the numeral I, having a pointed lower end 2 and a head 3 on the opposite end externally screw-threaded to receive a portion of the instrument or a cap 4. The nail i is tubular in form, having a .passageway 5 therethrough from its upper end. The head 3 of the nail I has a neck connecting the head and the body and of gradually increasing diameter from the body end, which would cause impaction of the fracture by means of the force used in insertng the nail through the fracture. The tightening of the cap i on the head 3 produces and maintains forceful impaction of the fracture.
The end portion of the passageway 5 is inter nally screw-threaded at 6, adapted to receive a portion of the instrument as hereinafter described. The opposite end of the passageway ii is formed with a reduced shoulder l therein adjacent to an angular drilled hole 8, one wall of which is designated 9 and is drilled at an angle to the longitudinal axis through the nail.
The passage 5 is adapted to receive a fracture securing pin W, the body of which is internally threaded at one end at i i (Fig. 5) while the opposite end of the pin is reduced in size relative to the body as indicated in i2 and is adapted to extend through the reduced portion of the passageway 5 and to engage the shoulder 53 to be deflected laterally as shown in Figs. 1, 5 and 6 when force is applied to the outer end of the pin.
The instrument for inserting or removing the nail and pin is shown in detail in Figs. 5 to 7. This instrument comprises a driving and extracting sleeve generally indicated at 13, provided with a cap i on one end thereof, which cap is detachable as by a screw-threaded connection with the end of the sleeve !3. Cap i i is employed during the insertion of the nail and pin, while cap i4 (Figs. 6 and 7) is used during the nail and pin extraction operations. The two caps, 14 and I l, are identical in construction except that [4 has no threaded connection with the bolt IS. The opposite end of the sleeve I3 is internally threaded at 95 for detachable connection of a pin guide l6 thereto when the instrument is used as shown in Figs. 5 and 6. One end of the :pin guide has a screw-threaded connection with the adjacent end of the screw 13, while the opposite end of said pin guide is provided with an internally threaded socket ll, adapted for threaded connection with the head of the nail i, as shown in Figs. 5 and 6.
Extending longitudinally through the sleeve i3, is a bolt [8, having externally screw-threaded connection with the cap i l, and extending outwardly therethrough. The projecting end portion of the bolt 18 is adapted for screw-threaded connection with a T-nut l9, which may be loosely threaded on the bolt i8, as shown in Fig. 6, or secured tightly thereon by an Allan nut 20, in the position shown in Fig. 5, which Allan nut 20 engages in a depression (not shown) in the proximal end of the bolt IE to secure the T-nut in a fixed position for the purpose of driving 4 the internal pin. An internally threaded socket St is formed in the proximal end of bolt 18, the socket being coaxial with respect to the longitudinal axis of the bolt, and serves a purpose to be described.
This T-nut I9 may be provided with a mark or indicia on the upper face thereof, to indicate the position of the lateral recess for the screw 20 in the bolt IS. A similar mark or indicia is shown at 2i on the end of the nail l in Fig. 3 to indicate the position of the foramen.
For inserting the pin ill, a rod 22 has one end 32 disposed in a socket 23 in the lower end of the bolt iii which is free to rotate therearound, while the opposite end portion of rod 22 extends downwardly through the pin guide it and through the nail 5, having a reduced lower end in threaded engagement with the socket H in the pin It as shown in Fig. 5. This provides a positive connection with the pin, which permits the latter to be forced through the nail and deilected laterally as shown in Fig. 5. In forcibly removing the pin It, the cap it is substituted for cap i4 and the rod i8 is reversed in order to establish a screw thread'connection between the internally threaded socket 343 and the threaded end 32 of the rod 22 as shown in Fig. 8.
When it is desired to remove the nail from the bone, the rod 22 may be removed after the extraction of the pin, and the bolt is can be connected directly with the nail I through a coupling member 25. The coupling member 25 has a reduced end adapted for screw-threaded engagement into an enlarged socket 28 in the lower end of the bolt [8 concentric with the socket 23, which latter forms a continuation thereof, while the opposite end of the coupling member 25 engages in screw-threaded connection with the internally threaded portion 6 of the nail The use of the instrument and the nail will be evident from the foregoing description and as hereinafter described, it being shown in Fig. 1 applied to a bone fracture, and in Fig. 2 the nail is shown applied to a bone plate, generally designated at 2? and secured in the usual manner.
The nail consists of a neck of gradually increasing diameter for the purpose of causing impaction on insertion. Said nailpossesses a head which is threaded for the'purpose of engaging a screwed nut cap, said screwed nut cap being threaded on the inside to a depth greater than the length of the head so that when the nail is inserted and the cap is tightly applied, the base of the cap would cause pressure upon the outer segment of a fracture producing forced impaction.
The depth and length in which the internal pin can be inserted is of great importance in reaching hard, dense, subcortical bony tissue.
The length of which the lateral deflection of the pin can be controlled by the operator'to any desired depth is for the purpose of engaging and preventingrotation of one fragment of a Iracture. I
While the invention has been illustrated and described in one embodiment, it'is recognized that variations and changes may be made therein without departing from the invention except as specified in the claims.
1. An instrument'for securing fragmentsof a bone fracture, comprising a tubular nail, having an offset opening in a side thereof, with an'angular face extending traversely of the axis of the nail, a pin slidably mounted'and-entirelycontained within the nail, said pin having a shank in position to engage said face and to be deflected laterally through the opening, means connected with the nail for holding said nail in place, and means in position to apply continuous pressure to said pin moving said pin relative to the nail and against the angular facewhile held by the first mentioned means.
2. An instrument for securing fragments of a bone fracture, comprising a tubular nail, having an offset opening in a side thereof, with an angular face extending traversely of the axis of the nail, a pin slidably mounted and entirely contained within the nail, said pin having a shank in position to engage said face and to be deflected laterally through the opening, a tubular guide connected with the nail, and pressure applying means operatively connected with the guide and in position to move the pin relative to the nail against the angular face for deflection thereby.
laterally through the opening, a sleeve operatively connected with the nail, pressure applying means 'operatively connected with the sleeve and movable lengthwise relative thereto, and means interposed between the pressure applying means and the pin, for applying pressure to the pin to move the latter relative to the nail in engagement with the face of the opening, causing a bending of the pin into holding relation with the bone fracture.
4. An instrument for securing fragments of a bone fracture, comprising a tubular nail, having an offset opening in a side thereof, with an angular face extending traversely of the axis of the nail, a pin slidably mounted and entirely contained within the nail, said pin having a shank in position to engage said face and to be deflected laterally through the opening, a sleeve operatively connected with the nail, pressure applying means operatively connected with the sleeve and movable lengthwise relative thereto, and means interposed between the pressure applying means and the pin, for applying pressure to the pin to move the latter relative to the nail in engagement with the face of the opening, causing a bending of the pin into holding relation with the bone fracture, and means forming a connection between the pin and the interposed means for causing an extraction of the pin from the bone fracture upon moving of the pressure applying means in the opposite direction.
5. A fracture securing instrument for a nail having a pin therein, comprising a sleeve having a head on one end thereof, a bolt extending lengthwise through the sleeve and head and having means for moving the bolt lengthwise relative thereto, and a rod at the inner end of the bolt in position to engage the pin for applying inserting pressure to the pin upon lengthwise movement of the rod in one direction.
6. A fracture securing instrument for a nail having a pin therein, comprising a sleeve having a head on one end thereof, a pin guide detachably connected with the opposite end of the sleeve, a bolt extending lengthwise through the sleeve and having a threaded connection with the head,
.pin for applying inserting pressure to the pin to deflect the pin upon movement of the bolt in one direction, and means forming a detachable connection between said rod and the bolt.
8. An instrument for securing fragments of a bone fracture, comprising a tubular nail, having an offset opening in a side thereof, with an angular face extending traversely of the axis of the nail, a pin slidably mounted in the nail and having a shank in position to engage said face and to be deflected laterally through the opening, a sleeve, a bolt extending lengthwise of the sleeve and having threaded connection therewith, and
means providing a detachable connection between the bolt and the nail to withdraw the nail from the bone fracture upon moving of the bolt in an outward direction.
9. A fracture nail comprising an elongated body having a head connected therewith by a neck of gradually increasing diameter outward from the body and outwardly from the point of penetration for causing impaction on insertion of said nail, a pin slidably mounted in the body, means on the body for deflecting the pin laterally of the body int secure engagement with the fracture, and said head being externally screwthreaded.
10. A fracture nail comprising an elongated body having a head connected therewith by a neck of gradually increasing diameter outward from the body and outwardly from the point of penetration for causing impaction on insertion of said nail, a pin slidably mounted in the body, means for deflecting the pin laterally of the body .into secure engagement with the fracture, said head being externally screw-threaded, and a cap screw-threaded on said head in position to cause pressure on the outer portion of the fracture when secured on the head.
11. A hip fracture nail comprising a tubular .body having an elongated shank adapted for insertion into bone structure, an elongated cylindrical element slidably mounted in the shank, means in the shank in the path of the cylindrical element for deflecting the end of the cylindrical element laterally of the axis of the shank into permanent securing engagement with the fracture bone structure at one side of said shank, and said body having an enlarged externally screwthreaded portion adjacent one of its ends.
12. A .nail for securing together fragments of a bone fracture, said nail comprising an elongated substantially cylindriral member having an enlarged proximal end and a pointed distal end, said member having an elongated cylindrical passageway formed therein and extending coaxially with respect to the longitudinal axis of said member from said proximal end to a point intermediate said proximal and distal ends, said passageway then continuing toward said distal end at an angle to said axis and opening in a side of said member adjacent said distal end, said passageway slidably receiving an elongated cylindrical element therein, and said en- 7 larged proximal end having interior and exterior threads formed thereon for connection with means for inserting said nail and pin into said bone fragments and means for Withdrawing said nail and pin from said bone fragments.
13. A device of the type described comprising an elongated tubular sleeve, a cap threadedly mounted on one end of said sleeve, said cap having a central threaded opening formed therein, an elongated bolt threadedly mounted in said opening and extending at one of its ends into said sleeve at one side of said opening at one side of said cap, said bolt having its other end projecting beyond the other side of said opening at the other side of said cap, a manually operated handle, means detachably securing said handle on said other end of said bolt, said one end of said bolt having a recess formed therein coaxial with the longitudinal axis of said bolt, a tubular guide member having one of its ends threadedly connected with said other end of said sleeve, said guide member having its other end threaded for connection with one endof a tubular fracture securing nail and having a passageway formed therein opening in a side of said nail, an elongated anchor pin for said nail slidably mounted therein, and a rod slidably mounted within said guide member, said rod being threaded at one of its ends for threaded connection with one end of said pin, [the other end of said rod being journaled within said recess whereby said bolt may be rotated relative to said rod.
14. A fracture securing instrument comprising an elongated tubular sleeve, a cap detachably mounted on one end of said sleeve, said cap having a threaded central opening formed therein aligned with the longitudinal axis of said sleeve, an elongated bolt threadedly mounted within said opening and having one end portion thereof on one side of said cap disposed Within said sleeve, said bolt having its other end projecting beyond the other side or said cap, manually operated handle means detachably connected to said other end of said bolt, a tubular guide member having one of its ends detachably secured to said other end of said sleeve, and slidably mounted within said guide member and. extending therethrough, said rod having one of its ends disposed within said sleeve and. in abutting relationship with said one end of said bolt, means on the other end of said guide member for detachable connection with one end of a tubular fracture nail, and. means .on the other end of said rod for detachable connection with one end of a pin slidably mounted within said nail.
15. A device of the type described comprising ing a central opening formed therein and thread- 6 edly mounted on said one end of said sleeve, an elongated bolt slidably mounted within: said opening and having one of its ends disposed within said sleeve at one side of said cap and its other end projecting on the other side thereof, an internally threaded recess formed in said one end of said bolt, a tubular guide member externally threaded at one of its ends for connection with the internally threaded other end of said sleeve, a rod slidably mounted in said guide member, one end of said rod being externally threaded for connection with said internally threaded recess formed in said one end of said bolt, said guide member having internal threads formed on the other end thereof for threaded connection with one end of a hollow tubular fracture securing nail, and said rod having threads formed on the other end thereof for connection with one end of a pin slidably mounted within said nail, and means coacting with said cap and other end of said bolt for withdrawing said pin from said nail.
16. An instrument for Withdrawing a fracture securing nail from fracture fragments comprising an elongated sleeve, a cap detachably secured to one end of said sleeve and having a central opening formed therein, an elongated exteriorly threaded bolt slidably mounted in said opening and having one end thereof disposed within said sleeve on one side of said cap, said bolt having its other end projecting on the other side of said cap, said one end of said bolt having an internally threaded recess formed therein, a coupling member slidably mounted within said sleeve and having opposed threaded ends, one end of said member being threaded into said internally threaded recess formed in said one end of said bolt, said other end of said member being adapted for connection with one end of said nail, and means coacting with said cap and said bolt for withdrawing said nail from said fracture fragments.
ALFRED T. PURIFICATO.
REFERENCES CITED The following references are of record in the file of this patent:
V UNITED STATES PATENTS Number Name Date 324,768 Hunt Aug. 18, 1885 2,077,804 Morrison i Apr. 20, 1937 2,187,852 Friddle Jan. 23, 1940 2,222,517 Price Nov. 19, 1940 2,327,434 Johnston Aug. 24, 1943 2,396,276 Lang Mar. 12, 1946 2,490,364 Livingston Dec. 6, 1949 OTHER REFERENCES Industrial & Engineering Chemistry for November 1937, page 1316. (Copy in Scientific Library.)
Catalog of De Puy Mfg. Co. of Warsaw, Indiana. 1943, pp. 48-49. (Copy in Div. 55.)