CA1248301A - Wrist implant - Google Patents
Wrist implantInfo
- Publication number
- CA1248301A CA1248301A CA000503422A CA503422A CA1248301A CA 1248301 A CA1248301 A CA 1248301A CA 000503422 A CA000503422 A CA 000503422A CA 503422 A CA503422 A CA 503422A CA 1248301 A CA1248301 A CA 1248301A
- Authority
- CA
- Canada
- Prior art keywords
- implant
- wrist
- proximal
- wrist implant
- carpal
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30138—Convex polygonal shapes
- A61F2002/30153—Convex polygonal shapes rectangular
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30884—Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
- A61F2002/4264—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists for radio-carpal joints
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0019—Angular shapes rectangular
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00029—Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
Abstract
WRIST IMPLANT
ABSTRACT
A wrist implant 50 for stabilizing the proximal carpal row and preventing ulnar migration thereof includes a body 52 having a generally planar, radial surface 56 which has a teardrop shape defined by curvilinear dorsal and palmar lateral edges 60, 62 and a semicircular medial edge 64. The body further defines generally triangular or wedge-shaped dorsal 72 and palmar 76 surfaces which join to form a curved medial surface 84. The body defines a smooth, cup-shaped, concave recess 90 including a lunate surface 92. The recess is configured to receive the carpal row lunate bone. The implant further includes a proximal stem 54 which extends perpendicular to the radial surface 56. The implant is adapted to be positioned at the distal end of the radius with the stem inserted into the intramedullary canal of the radius bone. The implant constrains the proximal row of the carpal bones, stabilizing the joint and preventing ulnar migration of the wrist bones.
ABSTRACT
A wrist implant 50 for stabilizing the proximal carpal row and preventing ulnar migration thereof includes a body 52 having a generally planar, radial surface 56 which has a teardrop shape defined by curvilinear dorsal and palmar lateral edges 60, 62 and a semicircular medial edge 64. The body further defines generally triangular or wedge-shaped dorsal 72 and palmar 76 surfaces which join to form a curved medial surface 84. The body defines a smooth, cup-shaped, concave recess 90 including a lunate surface 92. The recess is configured to receive the carpal row lunate bone. The implant further includes a proximal stem 54 which extends perpendicular to the radial surface 56. The implant is adapted to be positioned at the distal end of the radius with the stem inserted into the intramedullary canal of the radius bone. The implant constrains the proximal row of the carpal bones, stabilizing the joint and preventing ulnar migration of the wrist bones.
Description
WRIST IrlPLA~T
The present invention relates to arthroplastic reconstruction o~ the human joints and more particularly to implant arthroplasty of the wrist joint.
In recent years, various implan-ts have been successfully employed for the restoration of the joints of the hand and wrist affected with rheumatoid arthritis and similar conditions. Aseptic necrosis and/or arthritis of the carpal bones, either primary or secondary to trauma, is a frequent cause of disability of the wrist. Surgical treatment of conditions of the wrist have included intercarpal fusion, wrist fusion, local resection, proximal row carpectomy, bone grafting, radial styloidectomy, radial shortening or ulnar lengthening and soft tissue interposition arthroplasty.
The wrist is a key joint in the proper function of the hand. The wrist includes eight carpal bones arranged in rows of four each. The proximal row includes the pisiform, triquetrum, lunate and scaphoid bones. The distal row includes the hamate, capitate, trapezoid and trapezium bones.
The distal end of the radius bone of the arm articulates with the scaphoid and lunate carpal bones. The distal end of the radius also articulates with the head of the ulna. The joints between the carpal bones and the joint between the carpals and the radius permit wrist and hand movement.
Stability and mobility in the wrist are important for normal function of the extrinsic muscles of the fingers.
Rheumatoid arthritis is a frequent cause of severe wrist impairment. Such may affect the soft tissues and the joints of the wrist including the radiocarpal, intercarpal and radioulnar joints. The disease may re5ult in loosening - ~
, ~ .
, :
: . :
3~
of the ligaments and erosive changes in the bones. This disturbs the multiple link system of the wrist joint. In severe cases, the wrist may hecome completely dislocated.
Ulnar displacement of the proximal carpal row may result from loosening of the ligaments on the radial aspect of the joint.
Radial deviation of the hand on the forearm may then result.
Subluxation of the distal radioulnar joint associated with such deviation causes a loss of stability on the ulnar aspect of the wrist.
Various reconstructive procedures of a disabled wrist have heretofore been employed. These procedures include lunate and scaphoid implant arthroplasty using silicone rubber implants. The implants act as articulating spacers and maintain the relationship of adjacent carpal bones while preserving mobility of the wrist. Examples of such implants may be found in U.S. Patent No. 4,164,793 entitled LUNATE IMP~ANT and issued on August 21, 1979; and U.S. Patent No. 4,198, 712 entitled SCAPHOID IMPLANT and issued on April 22, 1980.
Wrist implant arthroplasty has been employed when instability of the wrist is caused by subluxation or dislocation of the radiocarpal joint. Radiocarpal joint implant resection arthroplasty has included resection of the lunate bone, part of the distal scaphoid, the capitate and the triquetrum bones, as well as the end of the radius and distal portion of the ulna. A double stem implant has been used with one stem inserted into the intramedullary canal of the radius and the other stem inserted in a channel reamed through the remnant of the capitate bone and the third metacarpal. In addition, an intramedullary stemmed, cuffed implant may be used to cap the resected distal ulna to preserve the anatomic relationships and physiology of the distal radioulnar joint following ulnar head resection.
~.
~ . .
In accordance with the present invention, a relatively rlgid wrist implant is provided for stabilizing the proximal carpal row to restrict or prevent ulnar translation of the carpal bones. Essentially, the implant includes a body which defines a proximal surface. Spaced palmar and dorsal sidewalls extend perpendicular to the proximal surface. The sidewalls join to form an end wall.
The end wall and sidewalls define a carpal recess dimensioned to receive a portion of the carpal row and prevent ulnar migration of the row.
In narrower aspects of the invention, the recess is undercut into the end wall and is dimensioned to receive the iunate bone of the proximal carpal row. The body is generally wedge-shaped in dorsal plan, and the proximal surface has a generally teardrop shape. The body further defines a proximal intramedullary stem dimensioned to be inserted into the intramedullary canal of the radius bone.
In the preferred form, the implant is fabricated as a one-piece member from a medical grade titanium alloy or a medical grade superalloy based on nickel and/or cobalt and to which chromium is added. The implant constrains the carpal bones, stabilizes the wrist joint and causes wrist motion to occur at the midcarpal joint. In addition, the implant may provide a distal buttress and surface for an ulnar head implant or cap~
FIG. 1 is a fragmentary, dorsal view of the hand, wrist and distal portions of the ulna and radius;
FIG. 2 is a fragmentaryj dorsal view of the hand, wrist and distal portions of the radius and ulna showing a wrist implant in accordance with the present invention;
FIG. 3 is a perspective view of the implant;
FIG. 4 is a dorsal view of the implant;
FIG. 5 is a medial end view of the implant;
~. :
' :.'',~
~:, ~'' FIG. 6 is a lateral end view of the implanti FIG. 7 is a cross-sectional view taken generally along line VII-VII of FIG. 5;
FIG. 8 is a view of the carpal surface of the implant; and FIG. 9 is a view of the proximal surface or bottom of the implant.
With reference to the drawings, FIG. 1 illustrates a dorsal view of a hand and wrist. The hand includes phalanges 12, metacarpals 14, a distal carpal row 16 and a proximal carpal row 18. The proximal carpal row is adjacent the radius 20 and the ulna 22. The distal carpal row 16 includes the hamate 24, the capitate 26, the trapezoid 28 and the trapezium 30. The proximal carpal row includes the pisiform 32, the triquetrum 34, the lunate 36 and the scaphoid 38. The distal end of the radius 20 includes a styloid process 40. The distal end or head 47 of the ulna includes a styloid process 44. In the wrist illustrated in FIG. 1, the proximal carpal row 18 has migrated medially towards the ulna 22. The radiocarpal joint between the radius and the scaphoid and lunate has been affected and severe wrist impairment is present. Ulnar displacement of the proximal carpal row is typically the result of rheumatoid arthritis.
In accordance with the present invention, a wrist implant generally designated 50 in FIG. 2 is provided to stabilize the proximal carpal row and constrain or prevent movement or ulnar displacement of the proximal row. As illustrated in FIG. 2, implant 50 is positioned between the distal end of the radius 20 and the proximal row 18 of the carpal bones. A portion of the radius ~0 has been resected and implant 50 is positioned to receive or trap the lunate . ., , , ~ ,.. .
~ , bone 36. Implant 50 in effect replaces the radiocarpal joint.
As seen in FIGS. 3-9, implant 50 includes a body portion 52 and an intramedullary stem 5~. sody portion 52 defines a proximal or bottom surface 56 (FIG. 9)~ Surface 56 has a generally teardrop shape and defines an apex 58, increasing radius, curved lateral or dorsal and palmar edges 60, 62, respectively, and a semicircular medial edge or base 64. Extending perpendicular to proximal surface 56 is an intramedullary stem 66. Stem 66 extends from a point generally centrally of surface 56. Stem 66 is an elongated, planar member having a rectangular cross section. Stem 66 tapers from surface 56 to an apex or point 68. As shown in FIG. 2, stem 66 is dimensioned to extend into the intramedullary canal of radius 20.
~ ody portion 52 is symmetrical about an axis 70 (FIG. 8). Body portion 52 includes a dorsal surface 72 defined by a sidewall 74 and a palmar surface 76 defined by a sidewall 78. Walls 74, 78 taper outwardly from an apex or lateral end 80. Walls 74, 78 join medially to define a medial end wall 82 having a surface 84. Surfaces 72, 76, as seen in FIG. 4, are generally triangular or wedge-shaped in plan. The sidewalls and end walls of portion 52 define a carpal recess 90. Recess 90 has a generally U-shaped or semicircular cross-section in a plane perpendicular to axis 70. Recess 90 tapers from the medial wall 82 towards the apex 80. Recess 90 is undercut at wall 82 to define a lunate surface 92. Recess 90 is configured so that lunate bone 36 is substantially disposed within the recess and partially encircled. The ulnar surface of the lunate abuts surface 92 of recess 90. Scaphold 38 is also partially received within recess 90, as shown in FIG. 2. The proximal surfaces of the lunate and scaphoid bones will contact the curved base or , .
bottom wall 96 of recess 90. The cup-shaped body porkion 52 and the surfaces of recess 90 define a radiocarpal joint.
Due to the configuration of the recess, the lunate bone and hence the proximal carpal row are in effect locked or constrained from moving toward the ulna 22. Movement of the carpal row is prevented. I~rist movement will shift to the midcarpal joint. Although movement is restricted, the wrist is stabilized and the pain associated with ulnar displacement of the carpal row is reduced or substantial]y eliminated.
It is presently preferred that the implant 50 be fabricated as a precision casting in a conventional fashion from titanium or a medical grade superalloy based on nickel and/or cobalt to which chromium is added for oxidation resistance. Such superalloys are well known in this industry. One such alloy is sold under the brand designation Vitallium. It is preferred that a plurality of implants of graduated size be provided to insure a stable fit with individual patients. Each of these implants would be graduated and have the same general proportions as the preferred embodiment illustrated~ The principal concern is to provide a cup-shaped recess to constrain or restrict ulnar translation of the carpal bones. Also, should he head of the ulna be resected and a cap implant provided, implant 50 could provide a distal buttress and surface for the ulna head implant. As clearly seen in FIG. 2, with the implant in position and the ligamentous structures repaired, the proximal carpal row is held in its proper relationship to the distal end of the radius.
In an existing embodiment of the wrist implant in accordance with the present invention, body portion 52 has an overall longitudinal dimension "a" of approximately 1.30 inehes and an overall width dimension "b" of approximately 0.625 inch, as indieated in FIG. 8. Medial surface 84 has an :, ,:, ~ : ~ ~
, :
overall heiyht "c" of approximately 0.475 inch, and apex 80 has an overall height "d" of 0.150 inch, as indicated in FIG.
4. The distal edge of medial wall 82 has a radius "r" of approximately 0.20 inch, as shown in FIG. 8. Stem 66 has an overall length designated "e" in FIG. 4 of approximately 1.4 inches. Stem 66 has an overall transverse dimension designated "g" at the proximal surface 56 of approxima-tely 0.70 inch. Stem 66 tapers to an overall transverse dimension designated "h" (FIG. 6) of approximately 0.30 inch at a distance "f" of approximately 0.50 inch from the proximal surface. Recess 90 has a highly polished or smooth finish and is cupped to conform generally to the exterior proximal surfaces of the lunate and scaphoid bones. Stem 66 has a thickness designated "t" (FIG. 6) of approximately 0.10 inch.
The wrist implant in accordance with the present invention is easily and relatively inexpensively manufactured using conventional fabrication techniques from suitable medical grade, high strength and wear resistant metals. A
relatively simple surgical procedure may be employed to repair the wrist and prevent ulnar migration of the carpal row. This results in increased stability and freedom from pain.
The above description should be considered as that of the preferred embodiment. The true spirit and scope of the present invention may be determined by reference to the appended claims.
_.
:
The present invention relates to arthroplastic reconstruction o~ the human joints and more particularly to implant arthroplasty of the wrist joint.
In recent years, various implan-ts have been successfully employed for the restoration of the joints of the hand and wrist affected with rheumatoid arthritis and similar conditions. Aseptic necrosis and/or arthritis of the carpal bones, either primary or secondary to trauma, is a frequent cause of disability of the wrist. Surgical treatment of conditions of the wrist have included intercarpal fusion, wrist fusion, local resection, proximal row carpectomy, bone grafting, radial styloidectomy, radial shortening or ulnar lengthening and soft tissue interposition arthroplasty.
The wrist is a key joint in the proper function of the hand. The wrist includes eight carpal bones arranged in rows of four each. The proximal row includes the pisiform, triquetrum, lunate and scaphoid bones. The distal row includes the hamate, capitate, trapezoid and trapezium bones.
The distal end of the radius bone of the arm articulates with the scaphoid and lunate carpal bones. The distal end of the radius also articulates with the head of the ulna. The joints between the carpal bones and the joint between the carpals and the radius permit wrist and hand movement.
Stability and mobility in the wrist are important for normal function of the extrinsic muscles of the fingers.
Rheumatoid arthritis is a frequent cause of severe wrist impairment. Such may affect the soft tissues and the joints of the wrist including the radiocarpal, intercarpal and radioulnar joints. The disease may re5ult in loosening - ~
, ~ .
, :
: . :
3~
of the ligaments and erosive changes in the bones. This disturbs the multiple link system of the wrist joint. In severe cases, the wrist may hecome completely dislocated.
Ulnar displacement of the proximal carpal row may result from loosening of the ligaments on the radial aspect of the joint.
Radial deviation of the hand on the forearm may then result.
Subluxation of the distal radioulnar joint associated with such deviation causes a loss of stability on the ulnar aspect of the wrist.
Various reconstructive procedures of a disabled wrist have heretofore been employed. These procedures include lunate and scaphoid implant arthroplasty using silicone rubber implants. The implants act as articulating spacers and maintain the relationship of adjacent carpal bones while preserving mobility of the wrist. Examples of such implants may be found in U.S. Patent No. 4,164,793 entitled LUNATE IMP~ANT and issued on August 21, 1979; and U.S. Patent No. 4,198, 712 entitled SCAPHOID IMPLANT and issued on April 22, 1980.
Wrist implant arthroplasty has been employed when instability of the wrist is caused by subluxation or dislocation of the radiocarpal joint. Radiocarpal joint implant resection arthroplasty has included resection of the lunate bone, part of the distal scaphoid, the capitate and the triquetrum bones, as well as the end of the radius and distal portion of the ulna. A double stem implant has been used with one stem inserted into the intramedullary canal of the radius and the other stem inserted in a channel reamed through the remnant of the capitate bone and the third metacarpal. In addition, an intramedullary stemmed, cuffed implant may be used to cap the resected distal ulna to preserve the anatomic relationships and physiology of the distal radioulnar joint following ulnar head resection.
~.
~ . .
In accordance with the present invention, a relatively rlgid wrist implant is provided for stabilizing the proximal carpal row to restrict or prevent ulnar translation of the carpal bones. Essentially, the implant includes a body which defines a proximal surface. Spaced palmar and dorsal sidewalls extend perpendicular to the proximal surface. The sidewalls join to form an end wall.
The end wall and sidewalls define a carpal recess dimensioned to receive a portion of the carpal row and prevent ulnar migration of the row.
In narrower aspects of the invention, the recess is undercut into the end wall and is dimensioned to receive the iunate bone of the proximal carpal row. The body is generally wedge-shaped in dorsal plan, and the proximal surface has a generally teardrop shape. The body further defines a proximal intramedullary stem dimensioned to be inserted into the intramedullary canal of the radius bone.
In the preferred form, the implant is fabricated as a one-piece member from a medical grade titanium alloy or a medical grade superalloy based on nickel and/or cobalt and to which chromium is added. The implant constrains the carpal bones, stabilizes the wrist joint and causes wrist motion to occur at the midcarpal joint. In addition, the implant may provide a distal buttress and surface for an ulnar head implant or cap~
FIG. 1 is a fragmentary, dorsal view of the hand, wrist and distal portions of the ulna and radius;
FIG. 2 is a fragmentaryj dorsal view of the hand, wrist and distal portions of the radius and ulna showing a wrist implant in accordance with the present invention;
FIG. 3 is a perspective view of the implant;
FIG. 4 is a dorsal view of the implant;
FIG. 5 is a medial end view of the implant;
~. :
' :.'',~
~:, ~'' FIG. 6 is a lateral end view of the implanti FIG. 7 is a cross-sectional view taken generally along line VII-VII of FIG. 5;
FIG. 8 is a view of the carpal surface of the implant; and FIG. 9 is a view of the proximal surface or bottom of the implant.
With reference to the drawings, FIG. 1 illustrates a dorsal view of a hand and wrist. The hand includes phalanges 12, metacarpals 14, a distal carpal row 16 and a proximal carpal row 18. The proximal carpal row is adjacent the radius 20 and the ulna 22. The distal carpal row 16 includes the hamate 24, the capitate 26, the trapezoid 28 and the trapezium 30. The proximal carpal row includes the pisiform 32, the triquetrum 34, the lunate 36 and the scaphoid 38. The distal end of the radius 20 includes a styloid process 40. The distal end or head 47 of the ulna includes a styloid process 44. In the wrist illustrated in FIG. 1, the proximal carpal row 18 has migrated medially towards the ulna 22. The radiocarpal joint between the radius and the scaphoid and lunate has been affected and severe wrist impairment is present. Ulnar displacement of the proximal carpal row is typically the result of rheumatoid arthritis.
In accordance with the present invention, a wrist implant generally designated 50 in FIG. 2 is provided to stabilize the proximal carpal row and constrain or prevent movement or ulnar displacement of the proximal row. As illustrated in FIG. 2, implant 50 is positioned between the distal end of the radius 20 and the proximal row 18 of the carpal bones. A portion of the radius ~0 has been resected and implant 50 is positioned to receive or trap the lunate . ., , , ~ ,.. .
~ , bone 36. Implant 50 in effect replaces the radiocarpal joint.
As seen in FIGS. 3-9, implant 50 includes a body portion 52 and an intramedullary stem 5~. sody portion 52 defines a proximal or bottom surface 56 (FIG. 9)~ Surface 56 has a generally teardrop shape and defines an apex 58, increasing radius, curved lateral or dorsal and palmar edges 60, 62, respectively, and a semicircular medial edge or base 64. Extending perpendicular to proximal surface 56 is an intramedullary stem 66. Stem 66 extends from a point generally centrally of surface 56. Stem 66 is an elongated, planar member having a rectangular cross section. Stem 66 tapers from surface 56 to an apex or point 68. As shown in FIG. 2, stem 66 is dimensioned to extend into the intramedullary canal of radius 20.
~ ody portion 52 is symmetrical about an axis 70 (FIG. 8). Body portion 52 includes a dorsal surface 72 defined by a sidewall 74 and a palmar surface 76 defined by a sidewall 78. Walls 74, 78 taper outwardly from an apex or lateral end 80. Walls 74, 78 join medially to define a medial end wall 82 having a surface 84. Surfaces 72, 76, as seen in FIG. 4, are generally triangular or wedge-shaped in plan. The sidewalls and end walls of portion 52 define a carpal recess 90. Recess 90 has a generally U-shaped or semicircular cross-section in a plane perpendicular to axis 70. Recess 90 tapers from the medial wall 82 towards the apex 80. Recess 90 is undercut at wall 82 to define a lunate surface 92. Recess 90 is configured so that lunate bone 36 is substantially disposed within the recess and partially encircled. The ulnar surface of the lunate abuts surface 92 of recess 90. Scaphold 38 is also partially received within recess 90, as shown in FIG. 2. The proximal surfaces of the lunate and scaphoid bones will contact the curved base or , .
bottom wall 96 of recess 90. The cup-shaped body porkion 52 and the surfaces of recess 90 define a radiocarpal joint.
Due to the configuration of the recess, the lunate bone and hence the proximal carpal row are in effect locked or constrained from moving toward the ulna 22. Movement of the carpal row is prevented. I~rist movement will shift to the midcarpal joint. Although movement is restricted, the wrist is stabilized and the pain associated with ulnar displacement of the carpal row is reduced or substantial]y eliminated.
It is presently preferred that the implant 50 be fabricated as a precision casting in a conventional fashion from titanium or a medical grade superalloy based on nickel and/or cobalt to which chromium is added for oxidation resistance. Such superalloys are well known in this industry. One such alloy is sold under the brand designation Vitallium. It is preferred that a plurality of implants of graduated size be provided to insure a stable fit with individual patients. Each of these implants would be graduated and have the same general proportions as the preferred embodiment illustrated~ The principal concern is to provide a cup-shaped recess to constrain or restrict ulnar translation of the carpal bones. Also, should he head of the ulna be resected and a cap implant provided, implant 50 could provide a distal buttress and surface for the ulna head implant. As clearly seen in FIG. 2, with the implant in position and the ligamentous structures repaired, the proximal carpal row is held in its proper relationship to the distal end of the radius.
In an existing embodiment of the wrist implant in accordance with the present invention, body portion 52 has an overall longitudinal dimension "a" of approximately 1.30 inehes and an overall width dimension "b" of approximately 0.625 inch, as indieated in FIG. 8. Medial surface 84 has an :, ,:, ~ : ~ ~
, :
overall heiyht "c" of approximately 0.475 inch, and apex 80 has an overall height "d" of 0.150 inch, as indicated in FIG.
4. The distal edge of medial wall 82 has a radius "r" of approximately 0.20 inch, as shown in FIG. 8. Stem 66 has an overall length designated "e" in FIG. 4 of approximately 1.4 inches. Stem 66 has an overall transverse dimension designated "g" at the proximal surface 56 of approxima-tely 0.70 inch. Stem 66 tapers to an overall transverse dimension designated "h" (FIG. 6) of approximately 0.30 inch at a distance "f" of approximately 0.50 inch from the proximal surface. Recess 90 has a highly polished or smooth finish and is cupped to conform generally to the exterior proximal surfaces of the lunate and scaphoid bones. Stem 66 has a thickness designated "t" (FIG. 6) of approximately 0.10 inch.
The wrist implant in accordance with the present invention is easily and relatively inexpensively manufactured using conventional fabrication techniques from suitable medical grade, high strength and wear resistant metals. A
relatively simple surgical procedure may be employed to repair the wrist and prevent ulnar migration of the carpal row. This results in increased stability and freedom from pain.
The above description should be considered as that of the preferred embodiment. The true spirit and scope of the present invention may be determined by reference to the appended claims.
_.
:
Claims (11)
1. A wrist implant 50 for stabilizing the proximal carpal row and preventing ulnar migration thereof, said implant comprising:
a body 52 defining a generally planar, radial surface 56 having a generally teardrop shape and including an apex 58, curvilinear dorsal and palmar lateral edges 60, 62 and a semicircular medial edge 64;
a generally triangular-shaped dorsal surface 72 having an apex 80 and extending distally from the dorsal edge 60 of said radial surface 56;
a generally triangle-shaped palmar surface 76 having a truncated apex 80 and extending distally from said palmar edge 62 of said radial surface 56, said dorsal surface 72 and said palmar surface 76 joining to form a curved medial surface 84; and a carpal surface defining an elongated, smooth, cup-shaped, concave recess 90 including a lunate surface 92, said recess 90 configured to receive and constrain the carpal row lunate bone.
a body 52 defining a generally planar, radial surface 56 having a generally teardrop shape and including an apex 58, curvilinear dorsal and palmar lateral edges 60, 62 and a semicircular medial edge 64;
a generally triangular-shaped dorsal surface 72 having an apex 80 and extending distally from the dorsal edge 60 of said radial surface 56;
a generally triangle-shaped palmar surface 76 having a truncated apex 80 and extending distally from said palmar edge 62 of said radial surface 56, said dorsal surface 72 and said palmar surface 76 joining to form a curved medial surface 84; and a carpal surface defining an elongated, smooth, cup-shaped, concave recess 90 including a lunate surface 92, said recess 90 configured to receive and constrain the carpal row lunate bone.
2. A wrist implant 50 as defined by claim 1 further including:
a proximal stem 54 extending generally perpendicular to said radial surface.
a proximal stem 54 extending generally perpendicular to said radial surface.
3. A wrist implant 50 as defined by claim 1 wherein said recess 90 is undercut towards said medial surface of said body.
4. A wrist implant 50 as defined by claim 2 wherein said recess 90 is undercut towards said medial surface of said body 52.
5. A wrist implant 50 as defined by claim 2 wherein said proximal stem 54 is an elongated, generally planar member 66 having a rectangular cross section.
6. A wrist implant 50 as defined by claim 5 wherein said stem 54 tapers from said radial surface 56 to a proximal free end 68.
7. A wrist implant 50 as defined by claim 4 wherein said proximal stem 54 is an elongated, generally planar member 66 having a rectangular cross section.
8. A wrist implant 50 as defined by claim 7 wherein said stem 54 tapers from said radial surface 56 to a proximal free end 68.
9. A wrist implant 50 as defined by claim 1 wherein said body 52 is fabricated from metal.
10. A wrist implant 50 as defined by claim 9 wherein said metal is titanium.
11. A wrist implant 50 as defined by claim 10 wherein said metal is a superalloy.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US709,332 | 1985-03-07 | ||
US06/709,332 US4645505A (en) | 1985-03-07 | 1985-03-07 | Wrist implant |
Publications (1)
Publication Number | Publication Date |
---|---|
CA1248301A true CA1248301A (en) | 1989-01-10 |
Family
ID=24849408
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA000503422A Expired CA1248301A (en) | 1985-03-07 | 1986-03-06 | Wrist implant |
Country Status (8)
Country | Link |
---|---|
US (1) | US4645505A (en) |
EP (1) | EP0198586B1 (en) |
JP (1) | JPS61276554A (en) |
AT (1) | ATE52905T1 (en) |
AU (1) | AU594940B2 (en) |
BR (1) | BR8600968A (en) |
CA (1) | CA1248301A (en) |
DE (1) | DE3671362D1 (en) |
Families Citing this family (28)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4936854A (en) * | 1988-12-22 | 1990-06-26 | Swanson Alfred B | Semi-constrained wrist implant |
CA2078840C (en) * | 1991-09-24 | 1998-08-11 | Alan J. Yeadon | Wrist prothesis |
US5326366A (en) * | 1993-02-16 | 1994-07-05 | Wright Medical Technology, Inc. | Biomechanical great toe implant |
US5674297A (en) * | 1995-12-08 | 1997-10-07 | Lane; Lewis B. | Metacarpophalangeal prosthesis |
TR199801685T2 (en) * | 1996-02-29 | 1998-11-23 | Ege Ahmet | Anatomical replacement prosthesis system in the wrist and hand. |
US8105389B2 (en) * | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
US8940055B2 (en) | 2002-10-24 | 2015-01-27 | Biomet Manufacturing, Llc | Method and apparatus for wrist arthroplasty |
US8066777B2 (en) * | 2002-10-24 | 2011-11-29 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
US6746486B1 (en) * | 2002-10-24 | 2004-06-08 | Biomet, Inc. | Method and apparatus for total wrist angled back carpal plate |
US8372154B2 (en) * | 2002-10-24 | 2013-02-12 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
US8105390B2 (en) | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
US8052756B2 (en) * | 2002-10-24 | 2011-11-08 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
US8821581B2 (en) * | 2002-10-24 | 2014-09-02 | Biomet Manufacturing, Llc | Method and apparatus for wrist arthroplasty |
US8105388B2 (en) * | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
US7625408B2 (en) * | 2003-07-22 | 2009-12-01 | Avanta Orthopaedics, Llc | Prosthetic wrist implant |
US6969407B2 (en) * | 2003-12-22 | 2005-11-29 | Depuy Products, Inc. | Modular radial component for a total wrist arthroplasty |
US20050251265A1 (en) * | 2004-05-07 | 2005-11-10 | Calandruccio James H | Trapezium implant for thumb and method |
US7160331B2 (en) * | 2004-12-01 | 2007-01-09 | Mayo Foundation For Medical Research And Education | Sigmoid notch implant |
US20060282169A1 (en) * | 2004-12-17 | 2006-12-14 | Felt Jeffrey C | System and method for upper extremity joint arthroplasty |
FR2893247B1 (en) * | 2005-11-17 | 2008-08-29 | Bioprofile Sa | IMPLANT, PARTICULARLY PARTIAL IMPLANT OF THE HEAD OF CUBITUS |
US7608111B2 (en) * | 2006-01-24 | 2009-10-27 | Biomet Manufacturing Corp. | Methods and devices for resurfacing the wrist joint |
US8052755B2 (en) * | 2008-05-09 | 2011-11-08 | Remi Sciences, Inc. | Ulnar head prosthesis system |
US7875082B2 (en) * | 2008-05-09 | 2011-01-25 | Remi Sciences, Inc. | Ulnar head prosthesis system |
US8152854B2 (en) * | 2009-09-30 | 2012-04-10 | Imbriglia Joseph E | Resurfacing implant for the wrist and method of implantation thereof |
US8906097B2 (en) * | 2010-06-02 | 2014-12-09 | Spinecraft, LLC | Intervertebral implant facilitating unilateral placement, instruments and methods |
US9078758B2 (en) | 2011-05-12 | 2015-07-14 | Howmedica Osteonics Corp. | Wrist implant for carpal hemiarthroplasty |
US9186256B2 (en) * | 2011-08-19 | 2015-11-17 | Integra Lifesciences Corporation | Wrist implants and methods |
EP3170477B1 (en) | 2015-11-22 | 2020-02-19 | Medartis Holding AG | Scaphoid prosthesis |
Family Cites Families (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3879767A (en) * | 1972-01-26 | 1975-04-29 | Cutter Lab | Prosthesis for articulating body structures |
US3987500A (en) * | 1976-01-28 | 1976-10-26 | Schlein Allen P | Surgically implantable total ankle prosthesis |
US4131957A (en) * | 1977-08-12 | 1979-01-02 | General Atomic Company | Ball and socket prosthetic joint |
US4164793A (en) * | 1978-04-26 | 1979-08-21 | Swanson Alfred B | Lunate implant |
JPS6048087B2 (en) * | 1980-09-04 | 1985-10-25 | 三菱電機株式会社 | capacitor device |
-
1985
- 1985-03-07 US US06/709,332 patent/US4645505A/en not_active Expired - Lifetime
-
1986
- 1986-03-06 DE DE8686301583T patent/DE3671362D1/en not_active Expired - Lifetime
- 1986-03-06 JP JP61049488A patent/JPS61276554A/en active Granted
- 1986-03-06 AT AT86301583T patent/ATE52905T1/en not_active IP Right Cessation
- 1986-03-06 AU AU54377/86A patent/AU594940B2/en not_active Ceased
- 1986-03-06 CA CA000503422A patent/CA1248301A/en not_active Expired
- 1986-03-06 BR BR8600968A patent/BR8600968A/en not_active IP Right Cessation
- 1986-03-06 EP EP86301583A patent/EP0198586B1/en not_active Expired - Lifetime
Also Published As
Publication number | Publication date |
---|---|
AU5437786A (en) | 1986-09-11 |
DE3671362D1 (en) | 1990-06-28 |
JPS61276554A (en) | 1986-12-06 |
US4645505A (en) | 1987-02-24 |
BR8600968A (en) | 1986-11-18 |
EP0198586A2 (en) | 1986-10-22 |
EP0198586A3 (en) | 1987-08-12 |
ATE52905T1 (en) | 1990-06-15 |
AU594940B2 (en) | 1990-03-22 |
EP0198586B1 (en) | 1990-05-23 |
JPH0588139B2 (en) | 1993-12-21 |
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