US 2725053 A
Description (OCR text may contain errors)
NW, 1955 J. BAMBARA ET AL SURGICAL NAIL GUIDE Filed Oct. 26, 1955 ATTORNEY United States Pate SURGICAL NAiL GUIDE Jbhn Bambar-a -Bloomfield, ahd Mi'cha'el T. Modify;
GlenRidge, N; J t Application October 26, 1953, Serial No. 388,246
4 Claims. (Cl. 128-83) Our inventionrelates generally to.a.g uide for usevin inserting surgical'nail's and specifically 'to anail'guide for use in inserting nails for repair of hip fractures.
It is among the objects of our invention to provide a nail guide which is easy to insert.
It is a further object of our invention to provide a guide for the insertion of surgical nails which may be inserted along the axis of the neck of the hip bone and will automatically permit the accurate positioning of the surgical nails for the purpose of immobilizing the fractured hip bone.
It is yet a further object of our invention to provide a surgical nail guide which will unerringly position the nail in the hard cortical area of the hip bone, rather than in the soft central spongey tissue.
It is yet another object of our invention to provide a surgical nail guide which will enable the performance of the well-known Austin-Moore operation with a minimum amount of skill and experience, and in the speediest possible manner.
These objects and advantages as well as other objects and advantages may be achieved by the surgical nail guide illustrated in the appended drawings in which:
Figure 1 is a side elevational view of our nail guide;
Figure 2 is a top-plan view;
Figure 3 is a side view in perspective;
Figure 4 is a side elevational view of a femur; and
Figure 5 is a side view of a surgical nail.
Present techniques for causing the healing of hip fractures involves the driving of pins through the neck of the femur so that they traverse the fracture and enter the head. One pin is not sufficient and the positioning of the subsequent pins with reference to the original pins is very important, for if they are too close, they may not have sufficient immobilizing effect. If the pins are not properly placed, they may break through the end wall of the femur or through the side walls and cause improper mechanical immobilization.
The present invention is a guide to facilitate the insertion of four surgical pins or partially threaded nails. The device so facilitating such insertion is a guide which consists of a cylindrical shaft 11 approximately four inches in length, one-quarter inch in diameter and having a tapered tip 12, the taper commencing approximately one-half inch from the end and tapering to a blunt point. The opposite end of the shaft is provided with a cylindrical portion 17, approximately one and one-quarter inches in diameter and one inch in height. The cylindrical head portion 17 has a central passage 21 which is threaded so that it may be attached to the well-known Smith-Peterson driver which is ordinarily used for the insertion of implements into bony structures. Around this threaded central opening there are four diametrically disposed smooth bores or passages 18. These passages are disposed circumferentially about the passage 21 at ninety degrees from each other. It is preferred that they be spaced from each other, one inch apart. The periph- ICC 2* eral surface of the guide portionis knurled for convenience inlhandling. The useof our guide is as follows:
A determination. is made. of. the positionof the axis 15.15 of the neck 16 ofJthe femur 22." A d'rilLis then positioned in correspondence with this axis 15 -15. and the femur. 22 is drilled from. its outerface intoward the direction of, the head 19' until the hard surface of 'the femur 22' is traversed'and the softer. spongey inner. tissue 13 is encountered. The drilI is thenwithdrawn and the guide is attached to a Smith-Peterson driver.- Thetip 12 is inserted in the drilled. cavity and the driverisused to force the shaft axially through .t'heneck 16..of the femur 22 and into the head 19, untili't comes to rest a brief distance awayfrom the outer surface. Careshould be used to prevent the tip 1213f the" shaft l'l'ftom breaking; through the outer surface of'the head '19; The passages 18, if prolonged into the bone 22 would form holes 20 to receive nails 14. With the guide in place, a threaded pin 14 is inserted through one of the guide openings 18 and forced into the bone 22. The pin 14 is held by a hand chuck. When the pin 14 is inserted to the point where the threads are, it is rotated so that the threads 23 bite into the bone 22 and the nail 14 is revolved until it has entered into the bone a substantial distance. Then a second nail 14 is positioned in the second guide passage 18 and it is likewise held by a hand chuck and rotated until it has entered into the bone, the desired distance. The third and fourth nails 14 are similarly driven into the bone. Then, our guide 11 is withdrawn, leaving the four nails 14 protruding from the bone. By X-ray determination, the position of the nails may be checked and the dis tance of further insertion may be determined. Then the 'hand chuck will be used to adjust the nails 14 to the proper depths of insertion. Any portion of the nails 14 remaining extending beyond the surface of the bone, after maximum insertion has been achieved, will be cut off. A small portion, extending beyond the surface of the bone, however, is allowed to remain and a nut is applied to this threaded portion. The nut serves the purpose of preventing the nail from migrating either in or out of the bone.
When the guide is first axially inserted into the head of the femur, through the neck, X-ray determinations should be made to insure the exact axial positioning of the guide, for depending upon the accuracy of insertion of the guide, is the ultimate result of the insertion of the nails 14. If the guide is not precisely accurately inserted, it must be repositioned for without such proper positioning, the nails will not be ideally placed to insure perfect free alignment of the fracture. When the shaft 11 is properly positioned on the axis 1515, the guide slots 18, if prolonged into the femur 22 are four parallel passages 20, equidistant from each other and equidistant from the axis of the neck 16.
The foregoing description is merely intended to illustrate an embodiment of the invention. .The component parts have been shown and described. They each may have substitutes which may perform a substantially similar function; such substitutes may be known as proper substitutes for the said components and may have actually been known or invented before the present invention; these substitutesare contemplated as being within the scope of the appended claims, although they are not specifically catalogued herein.
1. A surgical nail guide comprising a cylindrical shaft, a tapered pointed tip at one end of the shaft, a cylindrical head at the other end of the shaft having a substantially greater diameter than the shaft, a means in the head coaxial with the shaft for attaching a driver, a plurality of passages through the head disposed in parallelism with the shaft and radially equidistant therefrom and from each other.
2. A surgical nail guide comprising a cylindrical shaft, a tapered pointed tip at one end of the shaft, a cylindrical head coaxially secured to the other end of the shaft, a means on the head for attaching a driver, a plurality of passages through the head disposed in parallelism with each other and with the shaft and radially equidistant therefrom.
3. A surgical nail guide comprising a cylindrical shaft, a tapered pointed tip at one end of the shaft, a cylindrical head secured to the other end of the shaft having a substantially greater diameter than, the shaft, a means in the head coaxial with the shaft for attaching a driver, four passages through the head disposed in parallelism with the shaft and radially equidistant therefrom and from each other.
4. A surgical nail guide comprising a cylindrical head, a central means on top of the head for attaching a driver References Cited in the file of this patent UNITED STATES PATENTS 1,590,459 Vondersaar June 29, 1926 2,340,670 Lehman Feb. 1, 1944 2,500,370 McKibben Mar. 14, 1950 FOREIGN PATENTS 823,640 Germany Dec. 6, 1951 OTHER REFERENCES The Journal of Bone and Joint Surgery, May 1949, vol. 31-B, page 201. (Copy in Scientific Library.)