US 3118444 A
Description (OCR text may contain errors)
Jan. 21, 1964 J. c. SERRATO, .IR
FOREARM ROD FOR FRACTURES 3 Sheets-Sheet 1 Filed Nov. 20, 1961 Jos C. Serrafo, Jr.
9 BY an! Jan. 21, 1964 J. c. SERRATO, JR
FOREARM ROD FOR FRACTURES 5 Sheets-Sheet 2 Filed Nov. 20, 1961 Fig. 7
Jos C. Serrafo, Jr.
1 N VEN TOR. 40%. "Harm,
BY QM Jan. 21, 1964 J c. SERRATO, JR
FOREARM ROD FOR FRACTURES 3 Sheets-Sheet 3 Filed Nov. 20, 1961 Jose C. Serrafo; Jr.
United States Patent 3,118,444 FOREARP/i R01) FGR FRACTURES .los C. Serrate, 52x, Doctors Bldg, Columbus, Ga. Filed Nov. 2d, 1961, Ser. No. 153,435 5 Claims. (Cl. lid-92) This invention comprises a novel and useful forearm rod for fractures together with a method of surgically installing the rod in the radius and/or ulna bones of the forearm.
In fractures of the radius or ulna bones of the forearm or of both bones it is frequently desirable to facilitate the bone healing operation by installing surgeons pins within the medullary canals of the bones. I-leretofore it has been -a difficult and somewhat uncertain operation to effect this result owing to the difficulty of obtain ing proper alignment of the bores which must be drilled in the adjacent ends of the two portions of the broken bone, and the further difficulty of securing a sufiicient length of the surgeons pin in each of the bone portions.
Further, since the bones themselves are not straight but are usually curved to Varying extents, the problem of inserting a metallic pin in such non-rectilinear passages in the two bone sections is likewise a complicated operation.
A still further complication attending the healing of broken bones arises from the pronounced tendency of the two portions of a broken forearm bone to migrate in directions dependent upon the location of the break because of the forces applied to the bone portions by the attached system of muscles and ligaments.
It is therefore the primary purpose of this invention to greatly facilitate and improve the operation of setting fractured bones in the forearm and inserting surgeons pins in such bones in order to insure their proper alignment during the healing process.
A further object of the invention is to provide an improved surgeons pin for more effectively performing the foregoing operation and which will provide adequate strength to rigidly retain the bone portions in proper alignment during the healing process and yet which pin will readily accommodate itself tovarying curvatures of the bones in which the pins are inserted.
Yet another purpose of the invention is to provide a surgeons pin in accordance with the foregoing objects which may be formed in one standard length and of not more than three standard diameters in order to be effectively utilized in the setting and healing of fractured forearm bones regardless of the sizes of the bones in different patients.
Yet another object of the invention is to provide a surgeons pin and a process for applying the same which will greatly facilitate the operation of inserting metallic pins in fractured bones of the forearm to facilitate the setting of the bones and the healing of the fractures.
In accordance with this invention there is provided a surgeons pin or rod for fractures of one or both bones of the forearm. This pin or rod is capable of use in any fracture of one or both bones of the forearm as long as these fractures occur in the four middle sixths of the bones. The pins are sturdy enough to maintain the alignment and anatomical relationship of the bones but they are also flexible enough to adapt themselves to all the curvatures of the bones and to resist displacing of the broken bone portions by the associated ligament and muscle systems.
Standardized rods in one size which is 12 inches long and selective in three different diameters of and of an inch are found to be satisfactory for all sizes and types of bones.
The pin or rod is of a suitable metal and has a smooth major portion 8 inches in length and pointed while its minor portion is four inches in length and is threaded with the threaded portion being of slightly larger diameter than the smooth portion of the pin. The rod or pin can be cut at all size lengths at either end depending upon the location of the fracture and the length of the bone by any conventional means customarily employed for cutting surgical pins. The rods or pins, due to their design will allow compression at the fracture site but will not migrate to the outside or inside due to its threaded portion thereof which fixedly retains that portion in the medullary canal of the bone.
In the insertion of these pins no special instruments are required except for a pin cutter, bone forceps and three drill points 8 to 10 inches in length and of the same diameter as the rods. An electric power drill may be employed or a hand operated drill can serve the same purpose. A mallet and a sleeve-like driving cap to loosely receive the threaded end of the pin or rod may alsobe utilized to assist in shifting the rod in the medullary canal to the final position.
The bores drilled into the adjacent end portions of the broken bone do not exceed one-half to one inch in length being primarily intended to open a guide passage in the harder cortex to properly direct the pin which is then easily pushed through the more spongy or cancellous matter within the bone.
The technique of applying a surgical pin or rod in accordance with this invention in fractures of the ulna bone is as follows: The forearm is first thoroughly prepared, scrubbed and draped in the standard orthopedic manner. Using the best surgical approach, the fracture site is exposed and the fractured end of the distal fragment of the ulna is held with a bone clamp. The medullary canal is identified and with the aid of a $5 or a drill point, the medullary canal is reamed distally toward the styloid process or wrist portion of the ulna not more than /2 to 1 inch. The distal fragment thus drilled is now released.
The proximal fragment of the ulna is then held with a bone clamp and exposed through the incision. The same drilling operation is performed with the drill point of the electric or hand drill reaming the medullary canal from the point of fracture proximately toward the olecranon or the elbow for a distance not exceeding /2 to 1 inch.
Next a rod of a proper size corresponding to the drilled bores is measured and cut to the right length of the ulna of the patient. It is desired that as much as possible of the threaded portion of the rod should go into the bone but special effort should be directed to prevent the junction of the threaded and smooth portion of the rod from crossing the fracture site.
During the act of healing material from the adjacent ends' of the broken bone portions at the site of fracture is absorbed. This requires corresponding movement of the adjacent ends, which movement is permitted by the sliding of the bone portions upon the smooth shank of the pin while the threaded end of the latter is firmly anchored.
The smooth portion of the rod should be directed to- Ward the styloid process or wrist portion of the ulna and the threaded portion of the rod should be directed toward the olecranon or elbow portion of the ulna.
Conveniently, the rod or pin has a smooth end inserted in the drill socket and the threaded end of the rod is then inserted through the fractured end of the proximal portion, with the threaded end of the rod being extended through the elbow and protruding therefrom. The entry of the rod is guided by the short drilled bore in the cortex of the bone into the cancellous matter. Thereafter, further penetration of the flexible rod follows the contour of the medullary canal. When the rod has been sufficiently inserted into the proximal portion of the bone and protrudes from the elbow portion of the forearm the desired extent, the drill is then secured to the threaded portion of the rod and employed to further advance the rod in order to bring the distal end of the rod even with the fracture site.
At this point, the distal or inward end of the rod is now flush with the fracture site of the proximal portion of the ulna bone. Accordingly, the fracture is now reduced with the two proximate portions of the ulna bone being rigidly clamped together in alignment.
The rod is now driven distally through the site of fracture and into the distal portion of the bone and towards the distal end of the ulna. X-rays are made at this point for control of the rod, the junction of its threaded smooth portion being brought as close as possible to the fracture site but being careful that they do not go beyond the same. The protruding threaded end of the rod which extends through the elbow is then driven inwardly by a mallet until it is flush with the bone. At this point the incisions are closed and dressings applied to the wound.
When it is desired to apply this operation to both the ulna and the radius bones of the forearm, the foregoing operation performed upon the ulna is first performed and thereupon a same operation is performed upon the radius. For this latter operation, the most suitable rod for fractures is 9 of an inch, although on some occasions particularly in patients with small bones or narrow medullary canal, it has been found necessary to use the of an inch rod. The technique of insertion of the rod for fractures of the radius differs slightly from the one of the ulna.
First, the fracture site is approached through the best surgical route, and once the fracture has been exposed the fracture end of the proximal fragment of the radius is held with a bone clamp. The medullary canal is then reamed from the fracture proximally or toward the head of the radius bone or distally toward the wrist thereof for a distance of /2 to 1 inch with a drill and if necessary with a of an inch drill.
Next the same operation is performed on the other fragment of the radius using the same size drill. During this operation extreme care is taken to avoid perforating the wrist joint. Next a small incision is made over the styloid process of the radius just medial to Listers tubercle. It has been found that on fractures of radius which have been located near the distal end of the radius, it is simpler to insert the pin or rod over the dorsal aspect of the bone just medial to Listers tubercle. Conversely, in fractures of the radius which are located away from the distal end of the bone toward the mid-shaft or close to the head of the radius, the lateral approach to the same seems to be the most suitable.
Once it has been determined whether or not to approach the radius through the lateral or dorsal aspect, a small incision is done on the skin and the bone is exposed. With the ,4 drill point, a small perforation is made on the cortex of the bone and is carried down to the medullary canal of the radius. This bore will not exceed /2 inch.
Next, the proper diameter rod, preferably a /52 of an inch is measured and cut to the proper length making sure that as much as possible of the threaded portion is preserved but care being taken that the junction of the two portions of the rod do not cross the fracture site. The smooth portion of the rod is driven through this orifice on the styloid process of the radius and the end of the rod is directed toward the medullary canal and pushed through the cancellous material toward the fracture site. This results in flexing of the rod. Once the end of the rod makes its appearance at the fracture site, the fracture is properly reduced and maintained in aligned position by means of a clamp. The rod is then driven to the proximal fragment of the radius by means of the drill. X-rays are made at this particular time to determine the exact position of the rod in the medullary canal and the general alignment of the bone. Once it is determined that the fracture is well set and in good alignment, and the rod is in its proper position, the protruding portion of the rod is driven flush with the bone by means of a driver cap and mallet and the soft tissues are properly closed.
It has been found advantageous to apply a long arm cast to the extremity and maintain the extremity immobilized for a period of eight to ten weeks. Once the cast is removed and it is determined that bony union and callus formation starts to occur, exercise of the joints above and below the forearm is instituted in order to prevent marked atrophy of the muscular groups and limitation of motion of the elbow or wrist joints.
For fractures of both bones of the forearm the above described technique is performed for each bone, and the setting and inserting of the pin or rod in the ulna is always performed first in order to give stability to the forearm making it much easier to set and insert the rod or pin in the radius thereafter.
These together with other objects and advantages which will become subsequently apparent reside in the details of construction and operation as more fully hereinafter described and claimed, reference being had to the accompanying drawings forming a part hereof, wherein like numerals refer to like parts throughout, and in which:
FIGURE 1 is a somewhat diagrammatic view showing in vertical longitudinal section a portion of a forearm having broken radius and ulna bones therein;
FIGURE 2 is a view similar to FIGURE 1 but showing the arm after pins or rods have been inserted in both of the broken bones;
FIGURE 3 is a fragmentary elevational view showing the improved surgeons pin or rod in accordance with this invention, parts being broken away;
FIGURE 4 is an end view taken from the left or threaded end of the pin or rod of FIGURE 3;
FIGURES 5-9 are somewhat diagrammatic views showing various steps in the method of inserting and applying the pin or rod in accordance with this invention; and
FIGURE 10 is an elevational view of a forearm upon the completion of the operation for installing pins or rods in both the radius and ulna bones.
In the accompanying drawings the numeral 10 designates the improved surgeons pin or rod specifically designed in accordance with this invention for insertion in the radius or ulna bones of the forearm to facilitate healing of such bones after a fracture has occurred. The pins are of any suitable material and being of elongated slender rod-like shape having a smooth portion 12 extending throughout the major portion or length of the rod from one end which is pointed as at 14, and having a threaded portion 16 at the other end thereof which extends through a minor portion of the length of the rod and terminates in a point 18. Preferably, the threaded portion has its threads 20 of slightly greater diameter than that of the smooth portion of the rod so that when the rod is inserted in a bore drilled with the same diameter as that of the smooth portion, the threaded portion of the rod will have an engagement with the wall of the bore which will tend to anchor the rod in place, in the bore.
It has been found preferable in accordance with this invention to form all of the rods or pins of the same length, namely about 12 inches and to provide three different sizes as %,2 and 2 inches in diameter. These diameters will accommodate bores drilled in the mcdullary canals of all sizes of radius and ulna bones of the forearms, and the desired length of the rod may be obtained by cutting off either end of the rod when necessary by the use of a conventional pin cutter, commonly employed by surgeons in the setting of bones by inserting pins or rods therein.
The material of the rod may be widely varied, it being an essential requisite that it shall be of sufficient rigidity and strength to maintain broken bones in alignment during the healing operation and yet of sufiicient flexibility to enable the pin or rod to flex and conform to the curvature of the bone into which it is to be inserted. Also, the pin must be resistant to physical and chemical conditions occurring within the anatomy of the body in which the pin is inserted.
'In order to understand the application of this pin in repairing bone fractures of the forearm, attention is next directed to FIGURES 1 and 2 of the accompanying drawings. In the diagrammatic illustration of a forearm therein the radius bone is designated generally by the numeral 349 while the ulna bone is indicated at 32. Further illustrated is a double fracture in which both bones are fractured along roughly the same region in the forearm. Shown exaggeratedly for a better understanding of the principles of this invention are the medullary canals 34 of the radius and ulna bones.
FIGURE 2 shows the position of the bone fragments after the pins or rods it) have been properly inserted into medullary canals of the bones. When so inserted, the pins will remain permanently in place and will permanently strengthen and reinforce the bone structure and during the healing operation will maintain the bones rigidly in proper alignment with each other.
An important feature of this invention, as shown in FIGURE 2 is that the threaded portions 16 of the two pins may be firmly seated or anchored in the medullary canals of their respective bone portions so as to prevent relative movement therebetween, while the other or smooth ends of the pins are capable of sliding movement in their medullary canals as may be necessary.
Indicated in these figures of the drawings the designations A and B respectively are the wrist and elbow portions of the forearm.
In order to understand more clearly the method of applying or inserting surgeons pins and rods in accordance with this invention attention is now directed specifically to FIGURES 59 of the accompanying drawings in connection with the following description.
Although generally similar, the technique and operation of inserting the surgeons pin or rod in an ulna bone is somewhat different from that for inserting a pin in a radius bone. It will be appreciated that either operation may be performed independently. However, when both bones are broken, and it is necessary to insert a pin in each bone, it is generally preferred to insert the pin in the ulna bone first since this gives a rigidifying effect upon the forearm which in turn facilitates insertion of the pin in the radius bone.
The operation or technique of inserting a pin in a broken ulna bone is as follows:
(1) After the site of fracture has been properly cleansed and the fracture is laid bare by an incision, the fractured ends of the ulna bone 32 are exposed at the incision as shown in FIGURE 5 with the distal portion 46 of the ulna bone being held by a clamp 42 in proper position. By means of a drill 4-4- and a suitable size drill bit 46 as previously mentioned, the medullary canal of the distal portion is then drilled from the site of fracture towards the wrist A, this bore extending about /2 to 1 inch.
(2) The clamp 42 is released from the distal fragment 4?. and is now applied to the proximal fragment 48 of the ulna and the drill 46 shown in FIGURE 5 is then run into the medullary canal of the proximal portion 43 for a distance of /2 to 1 inch. The drill is then removed.
(3) The next step is to measure the length of the pin desired in comparison with the ulna bone of the patient, the smooth head 12 of the pin being cut off to give the desired length of the pin, it being desired to retain as much as possible of the threaded end of the pin. However, if the plane of fracture is very close to either the elbow or the wrist of the patient it may be necessary to cut off portions of both ends of the pin in order to insure that threaded portions shall lie entirely on one side of the frac- 6 ture and the smooth portion entirely through the fracture and on the other side thereof.
(4) With the pin out to proper size, the pin is then engaged in the drill by its smooth end and the threaded extremity of the pin is then inserted in the medullary canal of the proximal portion through the fracture end thereof by rotation of the pin by the drill. This operation is continued until the threaded extremity of the pin projects beyond and exteriorly of the elbow for a desired distance as shown in FIGURE 6.
(5) The drill is now removed from the pin, and is applied to the threaded end which projects from the elbow and is operated to drive and position the severed end of the pin flush with the fractured end of the proximal portion.
(6) The distal and proximal portions are now aligned or reduced and are retained in such position by means of the clamp '59 as shown in FIGURE 7. Thereupon the drill is again rotated and pushed axially inwardly from the elbow towards the wrist until the pin is fully seated in the aligned medullary canals of the distal and proximal portions of the ulna bone. Thereupon the drill is removed, the pin is driven fiush with or is slightly recessed into the elbow and the incisions are closed and dressed.
To effect final seating of the pin as suggested in F1- U RE 8, the hammer 52 and the driving sleeve cap piece 54, engaged upon the threaded extremity of the pin, are utilized to assist in shifting the pins to its final position.
In inserting a pin in a radius bone a somewhat different technique is employed. As in the preceding operation, the site of fracture is cleansed, incisions are made to expose the fracture.
(1) With a proper size of drill bit, the medullary canal is then drilled in the proximal portion from the incision or fracture toward the elbow for a distance of /2 to 1 inch.
(2) 'Next, the distal portion is drilled from the place of incision toward the wrist for a distance of /2 to 1 inch.
(3) As in the preceding operation, the length of pin or rod is measured and cut to proper size.
('4) Next, the two distal and proximal bone sections are aligned with each other and secured as by a clamp 62. The distal section is shown at 60, while the proximal bone section is indicated at 64.
(5) With the two bone sections now aligned and clamped in aligned position, the pin is then engaged within the drill by its threaded end and is inserted smooth end first through the opening in the wrist and into the medullary canal and gradually while being rotated is forced into the aligned distal and proximal sections of the bone. This operation is indicated in FIGURE 9 of the drawings.
(6) Next, the drill is removed and the previously mentioned cap 54- is applied to the projecting threaded extremity of the pin when the latter projects through the orifice of the styloid process of the radius and by means of the hammer 52 and cap 54 the pin is then shifted to final position.
(7) The incisions are then closed as indicated at 66, 68, 7t} and 72 in FIGURE 10 and the form is then placed in a cast as may be necessary to enable healing of the bone and the forearm.
The choice of the two previously mentioned routes of surgical approach will to a considerable extent depend upon the selection of that plane of bowing of the flexible pin which will resist the tendency of the broken bone to migrate from the site of fracture under the influence of the system of muscles and ligaments.
The foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly all suitable modifications and equivalents may be resorted to, falling within the scope of the invention as claimed.
What is claimed as new is as follows:
1. A one-piece surgical pin for repairing fractures of the radius and ulna bones of the forearm comprising an elongated metal pin normally straight but readily laterally flexible and of a suitable length and diameter to be received entirely within and between the extremities of the medullary canal of the radius or ulna, said pin having at one end a smooth major portion of a suitable cross-sectional area and shape for sliding freely in the medullary canal and having at its other end a minor portion of a sufficiently diametrically enlarged cross-sectional area for constituting an anchor means for fixedly retaining said pin at said other end thereof in a medullary canal, said major and minor portions being so proportioned in length that said minor portion may be embedded and anchored fixedly in the medullary canal entirely at one side of the fracture site of a bone and with said major portion extending across the fracture site and being slidably received in the medullary canal at both sides of the fracture site, said pin being of a material possessing suffi cient lateral flexibility to cause it to laterally flex and readily adapt its shape to the curvature of a medullary canal as it is moved longitudinally therein.
2. The combination of claim 1 wherein said anchor means comprises an external screw thread upon said minor portion and of a pitch whereby upon longitudinal movement of the pin accompanied by rotation the screw thread will penetrate without disrupting the cancellous References Cited in the file of this patent UNITED STATES PATENTS 2,543,780 Hipps et a1 Mar. 6, 1951 2,570,465 Lundholm Oct. 9, 1951 FOREIGN PATENTS 1,080,370 France May 26, 1954 757,951 Germany Nov. 9, 1953 OTHER REFERENCES Journal of Bone and Joint Surgery, vol. 33A, April 1951, page 21 of the Advertisers relied on. (Copy in Div. 55.)
Journal of Bone and Joint Surgery, vol. 41a, July-Dccember 1959, 789 pp. (only pp. 1512-1514, Technique of Insertion and Extraction of the Nails relied upon). (Copy in Scientific Library.)