US 2833284 A
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Description (OCR text may contain errors)
y 6, 1958 H. A. SPRINGER PATELLAR NEEDLE Filed Feb. 25, 1957 INVENTOR.
HENRY A. SPRINGER ATTOR NEY United States Patent PATELLAR NEEDLE Henry A. Springer, Cincinnati, ()hio Application February 25, 1957, Serial No. 642,094
3 Claims. (Cl. 128340) The invention relates to means, as an elongated curved pin or needle, having a casing comprising a plurality of parts, particularly, but not exclusively, adapted for use by a surgeon or other person, to sew wire, or other suture, through a fractured patella, commonly known as a knee cap, and surrounding ligaments, fascia and the like, in order to manually place pieces of the fractured patella together in their proper and original positions and hold the same in such positions during the healing period.
In the past the usual surgical procedure when operating on a person having a fractured patella involved holes being drilled through the upper and lower fragments of the fractured patella, after which a wire is carried through the upper and lower fragments of the patella. Then the wire is tied over the ligaments on each side of the patella.
It has been found that this method and procedure causes considerable destruction to the ligaments along each side of the patella.
The objects of the invention are to provide simple, eflicient and practical means by the use of which a fractured patella can be repaired in a minimum period of time with minimum exposure of the wound, which means less trauma to the tissue; to provide means to allowthe two ends of the wire to come out at the same opening, whereby the bone fragments of the patella can be brought accurately together and the two protruding wire ends can be tied with such force that the wire not only brings the bone fragments in tight contact with each other but, also, the wire when tied will disappear into the deep layers of the ligaments. This is important because if knots of the suture are not buried deep, it may be noticeable, subsequently, under the skin and may even cause an ulceration of the tissue at this point; and to provide means whereby the wire can be accurately and quickly carried through proper and desired portions of the fractured patella, andthe adjacent ligaments.
Further objects and-details of the invention will be apparent from a consideration of the accompanying specification, claims, and drawings.
The invention consists in the combination of the elements, arrangement of parts and in the details of the construction, as hereinafter. claimed.
, In the drawings:
Fig. l is a plan elevational of a needle and the casings, with parts broken' away; i
Fig. 2 is a section taken on line 2 2 in Fig. 1;
Fig. 3 is front view of a broken knee cap or patellarof a human being, with skin and tissues laid back showing the needle in use transversely of the knee;
Fig. 4 is the same except the needle and wire thread is shown when in use vertically and longitudinally of the leg;
Fig. 5 is the same except that the wire thread, shown in dotted lines, is completely sewed into the knee cap, ligaments and tissues;
Fig. 6 is the same except that the wire thread has reunited the broken knee cap;
shown partly broken away, showing a modified use of the invention; and
Fig. 8 is an end view of the needles point.
In the preferred construction of the invention, I provide a surgical instrument comprising the curved pin or needle 1, having the eye 2 in its end 3, and having its end 4- formed with a sharp drill point 5 with three flanges 6, 7 and 8 adaptable for drilling a hole through a bone when the end 4 of the needle is manually rotated with the point 5 in frictional and pressure contact with the bone.
On the end 3, of the needle, is the casing or handle 9 which has relatively the same curve as has the needle whereby the casing can he slid along and over the needle. The diameter of the hole or bore 10 in the casing 9 is slightly larger than the diameter of the needle whereby when, as hereinafter fully explained, the wire 11 threaded in the eye 2 of the needle and its end/or loop 11, as shown in Fig. 3, may be manually pulled through the casing 9, when the loop 11' is compressed. The casing 9 is provided with a thumb screw 12 threaded in the inner end of the casing whereby the casing may be fixed in any desired position on the needle simply by the operator screwing the thumb nut inwardly until its inner end firmly and tightly contacts the needle.
On the end 4, of the needle, is the casing or handle 13 which has relatively the same curve as has the needle 1 whereby the casing can be slid along and over the needle. The diameter of the hole or bore 10 of the casing 1 is slightly larger than the diameter of the needle. The casing is provided with a thumb screw 14 threaded in the inner end of the casing 13 wherebythe casing may be fixed in any desired position on the needle simply by the operator screwing the thumb nut inwardly until its inner end firmly and tightly contacts the needle.
As above mentioned the purpose of this invention is to provide an instrument which is adapted to improve the technique in the treatment of comminuted fractures of the patella. By use of the needle 1, the wire 11 and the casings 9 and 13 the fragments 15 and 16 of a fractured patella 17 can quickly and efiiciently be sutured together within the capsular ligaments 18 surrounding the patella.
The operation on the fractured or broken patella 17 and use of the invention is as follows: First, an incision is made over the patella and the skin, with its under the skin subcutaneous tissue, is thrown back or reflected.
The fragments of the patella will be found to have retracted or separated leaving the knee joint surface open and in clear view. The blood and clots are then removed from the knee joint. Then, with the proximal fragments elevated, the superior portion of the patella ligament can be felt, as well as the upper fragment of the patella, to which is attached the patella ligament.
The casing 13 is removed from the needle 1, and the casing 9 is slid inwardly of the needle to the position shown in Fig. 3, and the wire 11 is threaded in the eye 2, of the needle, as shown in Fig. 3. The thumb nut 12 is manually tightened so that the casing 9 is immovable or tightly fixed to the needle. Then the operator, who may be a surgeon, physician or other person, grasps in his hand the casing 9 and contacts the drill point 5 of the needle at the proper point on the ligament 18 making the hole 19 and then he proceeds to contact the point of the drill 5 at the proper position or location on the patella, generally near the top thereof. Then the operator rotates the casing 9 thereby rotating the point 5 of the needle and he uses some pressure in order to drill a hole through the patella and makes holes in the adjacent ligaments. Then the operator loosens the thumb nut 12 and by use of plyers, or by attaching the casing .13 to the end 4 of the needle, he pulls the threaded wire 11 through the hole in the patella and transversely of the patella and also through the holes 19 and 20 in the ligaments. At the termination of this operation a few inches of the end 11 of the wire 11 is left protruding from the hole 19 in the ligaments first entered the point of the' needle. Then the operator inserts th'e point 5 of the needle into the same hole or opening 20 in the ligaments that was the exit for the needle. Then the point of the needle is pushed by the operator downward under the medial side ligaments to the distal end of the lower patellar fragment where the needles point makes its exit from the hole 21 and the wire threaded in the eye of the needle also is pulled through this hole 21. Then the operator inserts the point 5 of the needle into the same hole 21 in the ligament and alongside the patella. Now. the operator causes the needle to cut through the distal and lower edge of the lower fragment 16 of the patella and transversely of the patella and leg'of the patient. The needle comes out through the hole 22 in the lateral ligaments, and the wire follows through'the needle. Then the operator inserts the point 5 of the needle into the hole 22 in the ligaments. Then the needle is turned upward and is pushed through the lateral ligaments, making its exit through the first opening or hole 19 alongside the end 11 of the protruding wire 11. Then the operator pulls the needle in order to bring the wire through the hole 19, and the ends 11' and 23 of the wire are then tied together with considerable force so that the wire not only brings together the fragments of the broken or fractured parts 15 and 16 of the patella tightly together in their proper and original positions but, also, the knotted ends 11 and 23 of the wire are buried deep into the hole 19 in the ligaments to eliminate future ulcerations and painful effects to the patient as when the knotted ends of the wire are left in exposed position near the skin.
Afterward the skin, and its subcutaneous tissue are placed in proper positions over the patella.
An advantage of the invention is that the needle is curved, which greatly aids the operator in surrounding the tissue and, therefore, the needle and Wire closely hug the patella which is somewhat round.
Another advantage of the invention is that the casings 9 and 13 not only are usable as handles which the operator may grasp and hold conveniently, instead of the needle, when the needle and wire are being passed through the patella and ligaments, but also the casings 9 and 13, respectively, protect the eye 2 from being broken and the point 5 from being dulled when the needle is in storage or not in use as the thumb nuts 12 and 14 may be manually tightened to hold the casings in their protective positions on the needle.
Another advantage of the invention is that the needle is curved, whereby it may be conveniently inserted by the operator into the ligaments and bone at an angle inclined downwardly and inwardly and removed from the ligaments and bone at an angle inclined upwardly andoutwardly.
In Fig. 7 is shown a modified use of the invention.
it is well known that great difficulty has been experienced by surgeons, physicians and others, in holding certain abdominal incisions together properly and with dependability, after an operation on internal organs and when it is desired to sew up the incision.
The operation of the invention for this purpose is as follows: First, with the casing 13 removed from the needle 1, the needle is held with its body curving inwardly and then the point 5 of the needle is inserted into and through the skin 24 near the edge of the incision 25, and through the subcutaneous tissues, as by the operator grasping with his hand the casing 9 which has been secured to the end 3 of the needle by the thumb nut 12. In the meantime the bowels of the patient are manually pushed inwardly so that when the point of the needle approaches the bowels the movable direction of the point will be manually guided by the operator to cause the point to miss contact with the bowels and enter the inner lining of the abdomen beyond the incision, and thence upwardly at an angle through the subcutaneous tissues and the skin 26. Now the incision can be manually closed to the position shown in Fig. 7 and the needle manually moved so that the inner end of the casing 9 contacts the skin 24 adjacent the incision after which the casing 13 is manually slid onto the end t of the needle until its inner end contacts the skin 26 adjacent the incision. Then the thumb nut 14 is manually tightened whereby both casings 9 and 13, being in fixed relation to the needle, the incision is kept closed adjacent the respective inner ends of the casings. The number of needles, and their casings, necessary to hold an incision in closed position obviously depends upon the length of the incision.
From practical ex erience I believe that the form of the invention illustrated in the drawings and referred to in the above description, as the preferred embodiment, is efiicient and practicable. However, I realize that the conditions concurrent with the adoption and utilization of my invention will necessarily vary. Therefore, I desire to emphasize that changes in the details may be resorted to, when required, without sacrificing any of the advantages of the invention, as defined in the claims.
What I claim as new and desire to secure by Letters Patent is:
1. A surgical instrument for repairing a fractured patella of a human being and comprising a curved needle having a drill point on one end for manually drilling'h'ole's' in ligaments and parts of the patella, and having an. eye on the other end in which a wire is threaded to be pulled through said holes in the ligaments and the patella, and a casing slidable on said needle and having a bore stifficie'ntly large to permit said threaded needle to be pulled through said casing, and manually operative means t'osecure said casing in fixed relation at selected positions on said needle.
2. A surgical instrument for repairing a fractured patella of a human being and comprising a curved needle having a point on one end, and having an eye the other end, and a casing slidable on said needle and manually operative means to secure said casing in fixed relation at selected positions on said needle.
3. A surgical instrument for repairing a fracture of a patella and comprising a curved needle having a' drill point on one end, and an eye in the other" end to receive a suture, and a casing normally slidable on said needle, and manually operative means to fix saidcasing to'said needle.
References Cited in the file of this patent UNITED STATES PATENTS 373,372 King NOV. 15, 1887 659,422 Shidler Oct. 9, 1900 FOREIGN PATENTS 445,656 Great Britain Apr. 16, 1936 OTHER REFERENCES Bickham: Operative Surgery, 1924, pp. 372-376, vol. II.