US 2666430 A
Description (OCR text may contain errors)
Jan. 19, 1954 @[SPERT 2,666,430
'HI P NAIL AIMING AND GUIDING DEVICE Filed April 21, 1950 2 SheetsSheet 1 4 INVENTOR HUMBERTO A. GISPERT,
ATTORNEYS Jan. 19, 1954 G|$|= ERT 2,666,430
HIP NAIL AIMING AND GUIDING DEVICE Filed April 21, 1950 2 Sheets-Sheet 2 FIG. 4 H63 FIG. IO H6. 5
INVENTOR H. A; GISPERT ATTORNEY5 Patented Jan. 19, 1954 UNITED STATES PATENT OFFICE HI? NAIL AIMIN G AND GUIDING DEVICE Humberto Altamirano Gispert, Havana, Cuba Application April 21, 1950, Serial No. 157,310
Claims priority, application Cuba May 31, 1949 3 Claims.
The present invention relates to an apparatus for use in orthopedic surgery in cases of fractured bones were it is necessary to drive or introduce a nail, drill or wire in the bone.
The apparatus covered by this invention is of the two purposes class, that is, designed to carry out two different operations, which are :v to locate with great precision the exact point in the bone Where the nail, drill or wire is to be introduced, and to guide said nail, drill or wire so that it penetrates the bone at the predetermined point.
The principal object of the present invention is to provide an apparatus which, due to the fact that the center of the cross arm on th locating device coincides in space with the center of the tube in the guiding device when one of said devices is substituted for the other, all measurements being made directly on a radiograph by means of a protractcr and by counting the notches on the cross arm as they appear on the radiograph, thus eliminating the necessity of complicated mathematical calculations.
Another object of the invention is to provide, for such purposes, an apparatus which is so simple, compact and of such a reduced size that it can be easily handled, occupies very little space and can be conveniently carried from one place to another.
The description that follows, together with the annexed drawings will make other objects and advantages of the invention obvious to those skilled in the art.
In the drawings Figure 1 is a perspective view of the apparatus with the guiding device in position.
Figure 2 is a perspective view of the locating device.
Figure 3 is the apparatus of Figure I as seen from above.
Figure 4 is a frontal elevation of the same apparatus.
Figure 5 is a lateral elevation of the same.
Figure 6 is a perspective view of the guiding tube.
Figure '7 is a perspective view of the section of the guiding device on which the guiding tube is directly mounted.
Figure 8 is a perspective View of the lower or supporting section of the guiding device.
Figure 9 is a frontal elevation of the locating device.
Figure 10 is a lateral elevation of the. locating device. Figures 4, 9., 10 and 5- are arranged in the. drawing so as, to clearly illustrate that the center of the cross arm on the locating device coincides in space with. the center of th vertical rotation of the guiding tube.
Figure 11 is the locating device as seen from above.
In order to make the description clearer, I divide the apparatus into three parts, as follows:
.The supporting body. 2.-The locating device. 3.-The guiding tube device.
As best seen in Figure l, the supporting body consists of a square base on which are mounted two graduated guide bars 2, which are horizontal, parallel to each other and run from front. to back, on them is mounted a horizontal, graduated cross bar 3 which can slide along said bars 2 to any desired position and clamped there by means of screws 4. On cross bar 3 is slidably mounted erect. member 5 that can he slid along cross. bar 3 to any position and clampedthere by screws 6. Erect member 5 can be either solid. or tubular but in the case illustrated it is tubular and is furnished with. screw 7 which piercing the wall of member 5- near the upper end of the latter penetrates into the inner hollow space so that when either the locating or the guiding deviceis mounted on member '5 it can be clamped in position at the desired elevation. The construction just described allows member 5 to be moved both backward and forward and also sidewise, with respect to the base.
The localizing device ht consists simply of a piece which, when mounted on member 5 of the supportingbody, can be moved vertically on the latter and. clamped at any desired position by screw 7. Said piece (see Figure 2) consists essentially of a graduated bar l4, the zero point of said grad-nations will be described later, whichrises. vertically for a predetermined distance, then. projects horizontally backward as at Ida and finally rises vertically. portion Mb of the bar: includes a graduated horizontal cross arm Mcextended from left to right. The: point where the longitudinal axis of the rear face of the cross arm intersects the longitudinal axis of the rear face of said second vertical. portion of the bar, constitutes the zero point of the locating device, that is, the zero point of the scales of graduations on the arms and on the. vertical bar I40, said graduations on the arms and upper vertical portion I40 of the bar being marked by means. of notches on their rear faces. As shown. in the drawings, the ver tical. bar may have more than one cross. arm- As illustrated in Figures 6, 7 and 8, the guiding Said second vertical tube device is composed of three separable sections which will be referred to as the lower or supporting section 8, the upper or annular por tion 9 and the guiding tube l2.
Lower section 8, which is slidably mounted on member 5 of the supporting body of the apparatus so as to be movable vertically, consists of a straight, graduated, vertical bar to, to the top portion of which is attached a horizontal, graduated, semicircular plate 81) that projects forward, said plate being so united to said vertical bar that the center of the circular arc bounding the plate lies on the longitudinal axis of the vertical bar A portion of said bar projects above said plate, so that when the guiding device is assembled said projecting portion of the bar lodges in a suitable cavity on the lower face of section 9 and permits the latter to turn in a horizontal plane, said projection of the vertical bar being made cylindrical for that purpose. The lower portion of section 9 includes a pointer to that projects horizontally on the front of said section, so that when the latter is turned, the pointer moves with it over the graduated, semicircular plate 82; of section 8 and thus indicates the horizontal angle through which section 9 is moved. Said lower portion of section 9 is furnished with screw it which, passing through the wall of said section penetrates the cavity in which the upper portion of the bar 8a of section 8 is lodged, thus supplying means for clamping section 9 in any desired relation with section 3. Further up, section 53 divides into two spaced arms, with their inner faces curved, which after a certain distance unite again, thus enclosing a substantially elliptical opening of sufficient size to allow guiding tube :2 sufficient play, specially in a vertical plane, when it is mounted in said opening by means of two opposed and horizontally attached screws H which, after piercing at the same level the lateral walls of said elliptical opening, penetrate suitable cavities on the rear of guiding tube l2 so that the latter can turn on said screws H as on a horizontal axis. A short bar rising vertically from the top of the portion enclosing the elliptical opening has firmly attached to it the upper end of a relatively narrow plate in the form of an arc of a circle with centre of curvature on the axis passing horizontally through screws H, the arcuate plate descends in a vertical plane in front of section 9 so as to be spaced slightly to one side of tube l2 when the latter is mounted on screws H, the lower portion of said arcuate plate is graduated and has an arcuate slot through which screw l3 passes in order to be screwed in a threaded hole near the forward end of tube 12.
To assemble the guiding device the projecting portion of the bar ea of section 8 is introduced in the cavity on the lower face of section 9 and screw i9 is tightened, tube 82 is then introduced in the elliptical opening of section 9 and screws H turned in till their ends lodge in the cavities near the rear end of tube I2, screw 13 is then passed through the slot in the vertical circular arc and screwed in the hole near the front end of tube l2. On tightening screw 53 tube I2 is clamped and prevented from turning in a vertical plane. Having assembled the guiding device, the lower end of the bar to on section 8 is introduced at the top of member 5 of the supporting body of the apparatus and clamped in the desired position with screw l. Screw Hi is then loosened and section 9 is rotated horizontally till the pointer indicates zero on the horizontal,
graduated semicircular plate, then screw it is again tightened to clamp section a in that posi tion. Screw I3 is loosened and guiding tube is rotated in a vertical plane till screw 23 coincides with the zero of the scale on the vertical circular arc, then screw 13 is tightened to preserve that adjustment. Under these conditions, that with the pointer on the zero of the scale on the horizontal circular plate and screw it on the zero of the scale on the vertical are, the longitudinal axis of guiding tube i2 is horizontal and perpendicular to the vertical axis passing through memher 5 of the supporting body of the apparatus and through sections 8 and 9 of the device and is also perpendicular to the axis passing through screws 5 I. Said three axes intercepting at a point which is the origin to which all Id as urements are referred.
The apparatus is used as follows:
dupposing that it is to be employed a case of a patient with a fracture of the neck of the femur and that it is desired to introduce a trilaminal nail (Smith Petersen) of the type commonly used in such cases, the patient is placed in a fixed position on the orthopedic table, the apparatus with the locating device is fixed to the table top at the level of the outer lateral face of the patients hip so that the center of the cross arm is at the level and outside of the base of the trochanter (bone). Two radiographs are then made, one from above and the other a lateral one. Then the locating device is removed from the apparatus and substituted by the guiding device including the guiding tube i2.
aving made the aforementioned radiographs, the front to back radiograph is taken which shows the projection on a horizontal plane of the neck of the femur (thigh-bone) and of the horizontal cross arm and by means of a straight edge ruler or other suitable instrument the axis of the neck of the femur is prolonged till it meets one of the branches of the cross arm at a di"- tanoe of, for example, X. notches from the intersection of the longitudinal axes of the vertical rod and said cross arm which is the zero point on the vertical and horizontal scales marked respectively on said vertical rod and cross arm. Said point coinciding with the point or center about which the guiding tube rotates, both vertically and horizontally, when later the guiding device is placed on standard 5 instead of the locating device and standard 5 is moved back on parallel members 2 a distance equal to that in which the upper vertical portion l ib is oifset backwards with respect to the 10'1- er vertical portion Hi.
The horizontal angle between the axis of th neck of the femur and the cross arm of t locating devicev is thus read off directly in radiograph from above.
The vertical angle is similarly obtained from the lateral radiograph by simply prolonging the axis of the neck of the femur till it intersects the vertical rod on which the cross arm is mounted and measuring the corresponding angle.
Once the two angles are found the locating device is taken oif and substituted on standard 5 by the guiding device which is placed at the same height at which the locating device had been held. Then the horizontal an le obtained in the radiograph from above is set off by means of the horizontal graduated semicircle and the vertical angle measured on the lateral radiograph is set ofi on the graduated vertical are and when this is done, the guiding tube is aiming in the precise direction in which .the nail is to be driven into the bone.
The relation between the graduations of the locating device and the bars 2, 3 and 8 is as follows:
The graduation of the locating device and t guiding device have been made in such form that if one substitutes the locating device for the guiding device and move from front to back th. bar 3 over 2 an equal distance to the length of the portion Ma of the locating device, they cor-- respond to the space the points of the two iece Since the graduations of the two pieces have been made in an equal form starting from the zero point one may adjust the graduations over the arms of the cross bar I40 of the vertical bar Mb to correspond with the bars 2, 3 and 8, as well as the movements of the locating tube. In the event that the piece l4 does not have the portion I Act and that the Mb prolonged upwardly, then the zero point of the locating device and the guiding device will correspond in the space when substituted for each other in the portion 5 and consequently the marks of the portion Mb will correspond with the marks of the piece 8 and of the portion 5 so that when the radiograph is observed, the center of the guiding tube may be dropped by two marks to coincide with the axis of the bone and with the second mark of the vertical portion Mb of the locating device, this done by dropping the guiding device (bar 8) by two marks on the portion 5. The portion 5 is perpendicular upwardly towards the bar 3, so that the axis of portion prolongs axis 5 upwardly, and Hia is perpendicular to M and I db to Illa. As the portion I40 is directed from right to left and perpendicular to Mb, the portion [40 is parallel to the bar 3, so that when the radiograph is studied, one may move the center of the guiding tube towards to the right by two marks and bring the axis of the bone in coincidence with the mark 2 of the portion I40, by moving the portion 5 'over 3 by two marks towards the right, He and 3 being parallel to each other. For the same reason Ma is parallel to 2. When substituting the locating device for the guiding device the piece 3 is moved over 2 by an equal distance to the portion Ma and this places the centers of the two pieces in coincidence.
In the front to back radiograph the distance existing between the center of the cross arm and the vertex of the angle formed by the axis of the neck of the femur with the horizontal cross arm is obtained directly :by counting the notches existing between both points, this distance is to be set by moving vertical member 5 on horizontal cross bar 3 (both of the supporting body of the apparatus) in order to locate the center of rotation of guiding tube I2 at the level of the direction of the axis of the bone. The same operation is performed with the lateral radiograph to rectify said center of rota-tion in a vertical direction. The tube is then in the required position.
1. Hip nail aiming and guiding apparatus consisting of a base with one of its axes in a front to back direction and the other running crosswise from right to left, two graduated bars extending from front to back and serving as supports for a graduated cross bar capable of moving in a front to back direction on said first two bars and of being fixed at the desired position by suitable holding means; said cross bar supporting a member that includes a vertical portion, said member being movable along said cross bar and capable of being held at the desired position by suitable holding means, the vertical portion of said member adapted to be a support for a device that includes a cross arm which, with the aid of radiographic examinations permits the determination of the positions of the bones with respect to the three planesof the apparatus and susceptible of substitution by a device which includes a guiding tube the universal center of which, as well as a horizontal and a vertical angle, may be set by the various graduated parts of the apparatus in accordance with what has been predetermined by means of the cross arm and radiographic examinations to guide the fixing means through the bones; both the cross arm and guidingtube being supported by the vertical member on which they are vertically movable and capable of being fixed at the desired position by suitable means.
2. Apparatus as claimed in claim 1, in which the device including the cross arm comprises a graduated bar that rises vertically for a predeter- V mined distance, then projects horizontally backward and finally rises vertically; said last vertical portion including a horizontal cross arm extended from right to left, the point of interception of the longitudinal axis of the rear edges of the cross arm and vertical bar corresponding with the universal zero of the apparatus or device, said point being the origin of the scales on the vertical bar and cross arm, the graduations on the cross arm and the portion of the vertical bar to which it is attached being in the form of notches to facilitate being easily seen on the radiographs, the second vertical portion of the rod including at least one cross arm.
3. Apparatus as claimed in claim 1, in which the device that includes the guiding tube consists of a vertical graduated bar which serves as a support for the guidingtube, the guiding tube being movable in two semicircles, one horizontal and the other vertical, around a vertical axis which is the longitudinal axis of the bar supporting the guiding tube and about another axis that is horizontal and so located that said two axes cross each other at the point of their intersection, said point coinciding with the center of the guiding tube, and being the starting point for' graduating downward the member that includes it as well as :being the center of both semicircles, the center of the horizontal semicircle being located at a point in the vertical axis and the center of the vertical semicircle being located at a point in the transverse axis.
HUMBERTO ALTAMIIRANO GISPERT.
References Cited in the file of this patent UNITED STATES PATENTS Number Name Date 2,226,708 Cleary Dec. 31, 1940 2,579,186 Haboush Dec. 18, 1951 FOREIGN PATENTS Number Country Date 245,831 Switzerland Aug. 16, 1947 OTHER REFERENCES Der Chirurgie for 1935, page 877.
Acta Chirurgica Scandanavia, for 1936, pages 26-30. Copies of both these publications are in Division 55.