DE3820768A1 - Universal holding apparatus for the ankle and talocalcaneonavicular joints - Google Patents

Abstract

The invention relates to a medical-technical X-ray holding apparatus which represents an absolute innovation all over the world in that it guarantees a standardised measuring method for testing the stability in the human talocalcanean and talocalcaneonavicular joint. The previous holding devices only permit standardised measuring techniques for the ankle joint which is additionally possible by the present holding device. The invention is based on the object of replacing the hand-held images of the talocalcanean and talocalcaneonavicular joint by a mechanical mounting. This object was achieved, according to the invention, in that the holding device was designed almost exclusively with an X-ray permeable material (Plexiglass). Heel support, foot position and direction of tension were arranged such that stress images were obtained that are comparable to the hand-held images of the talocalcaneonavicular joint or are even more accurate and more informative (Fig. 3n). The apparatus can be applied in standardised differential diagnosis for numerous patients with instability of the ankle, talocalcanean or talocalcaneonavicular joint (see literature) and, moreover, for radiation protection of the medical investigators. <IMAGE>

Description

The universal holding device for the upper and lower Ankle is used for standardizable radiography evidence of band instability in the upper, rear and / or front lower ankle. While various X-ray holding devices on the general market te exist for the upper ankle, there is the not a standardized time on the entire world market X-ray holding device for the lower rear and the front lower ankle. The core of the invention is Multivariance 3 different, standardized feet positions at 15 kp tensile load with simultaneous Transparency for the incident X-rays Use of plexiglass and other radiopaque materials. With 3 different pull directions

• a) outwards,
• b) inside,
• c) down,

a total of 5 diagnostic functions are achieved:

• 1. Lateral talus tilt in the upper ankle (pull a),
• 2. Medial talus tilt in the upper ankle / fork stability (train b),
• 3. Talus advance (upper ankle, pull c),
• 4. talo-calcanear tilt (rear lower jump  steer at train a),
• 5. calcaneo-cuboidal tilt (front lower jump joint at train a).

The overall construction of the universal X-ray holding device for the upper and lower ankle is a small mobile unit in the sense of a four-legged table with small castors, the top plate of the table being made of plexiglass. Its height and width are designed so that it can be attached to a standard X-ray table and locked with 2 small castors. On the plexiglass base plate (position 4 of Fig. 1) a Plexi glass tilting plate (position 7 of Fig. 1) is fixed perpendicularly via an angle hinge (position 5 of Fig. 1), resulting in lockable foot positions of 0 °, 12 ° and 45 ° Plantar flexion can be adjusted ( Fig. 2 b and 3). A rotatable plexiglass footplate is mounted on this plexiglass tilting plate (position 7 of Fig. 1), which specifies foot or lower leg positions of 25 ° or 45 ° internal rotation in the ap X-ray path (position 8 of Fig. 1, Fig. 2 a) . The forefoot of the patient to be examined is fixed on the footplate (position 8 of Fig. 1), which can be swiveled between 25 ° and 40 ° internal rotation, with 2 Velcro fasteners, the rear foot is fixed on a rotating disc with variable Plexi glass U profiles, so that a varus / valgus stress can be exerted on the ankles via a lateral or medial pull on the lower leg by means of a Velcro fastener cuff.

Depending on the instability level to be tested, a 15 kg iron block, which is connected by a chain with a Velcro fastener on the lower leg, exerts a pull on the outside or inside by gravity via a deflection roller (item 17 of Fig. 1). When pulling backwards and downwards, the chain with weight is fed directly to the 15 kg weight piece through a perforation in the table base.

There are 2 plexiglas beneath the table base sliding cassettes, which the X-ray film cassettes for record the AP beam path OSG and rear USG. Is located between the two swiveling foot plates a vertical cassette holder, which for opening the x-ray cassette in the side beam path serves to check the talus feed on the right or left. On the side of the plexiglass tilt Plate are 2 plexiglass plug-in cassettes, which for Recording of 2 x-ray cassettes, which serve the a.p. Projection for the front lower ankle to take.

The necessary tilting of the X-ray tube in relation to the universal X-ray holding device is shown in Fig. 2c, whereby the X-ray tube is not tilted in the ap ray path for the upper ankle, cranio-caudal for the front lower ankle by 25 °, for the rear lower ankle socket 45 ° caudo-cranial.

Fig. 3a-d illustrates the structure of the universal X-ray machine, e - h the adjustment techniques when examining the upper ankle, i - j when examining the rear lower ankle and kl the adjustment technique when examining the front lower ankle.

Claims (10)

1.Universal holding device for the upper and lower ankle joint for standardized radiological detection of ligament instability in the upper, rear lower and / or front lower human ankle, characterized in that it can be combined with any fixed X-ray table in a glass unit as a small, mobile plexi and 5 Different x-ray stress images (lateral talus tilt, medial talus tilt, talus advance, talo-calcanear tilt and calcaneo-cuboidal tilt) are allowed in 3 different ankle levels (upper, posterior and anterior lower). 2. Universal holding device for the upper and lower jump joint according to claim 1 characterized, that all essential parts of the holding device made of plexi glass or radiopaque materials where through combined with standardized foot and X-ray Adjustment technology instability under standard stress Conditions (15 kp train) in the rear lower and front lower ankle became possible for the first time. 3. Universal holding device for the upper and lower jump joint according to claim 1 or 2 characterized, that in the a.p. X-ray plane of the foot with the lower leg on a swiveling plexiglass base plate with Velcro fastener finally fixed and standardized 25 ° or 45 ° inside can be kept rotated, with the rear foot rotating held in variable plexiglass U profiles and the Lower leg over a Velcro fastener with Chain and 15 kp weight loaded by a pulley can be. 4. Universal holding device for the upper and lower jump joint according to one of the claims  characterized, that in the lateral x-ray plane the foot either in Right angle (rear USG mount), in 12 ° Plantar lesson (lateral OSG image in the sense of Talus feed) and in 45 ° plantar flexion of the foot in comparable right-left standard positions held becomes. 5. Universal holding device for the upper and lower jump joint according to one of the claims 1-4 characterized, that by 2 plexiglass sliding cassettes, one vertical Plexi cassette holder and 2 plexiglass plug-in cassettes correct positions of the X-ray film cassettes specified are. 6. Universal holding device for the upper and lower jump joint according to one of the claims 1-5 characterized, that in the ap x-ray path when pulling outward one lateral talus tilt (12 ° plantar lesson, 25 ° Internal rotation, 15 kp train) can be detected.   7. Universal holding device for the upper and lower jump joint according to one of the claims 1-6 characterized, that in the ap x-ray path when pulling inward one medial tipping or an ankle fork instability proven under the conditions described under 6 can be. 8. Universal holding device for the upper and lower jump joint according to one of the claims 1-7 characterized, that instability in the lateral x-ray path of the upper ankle by direct pull backwards under the conditions described under 6 within the meaning of Talus advance can be demonstrated. 9. Universal holding device for the upper and lower jump joint according to one of the claims 1-8 characterized,  that in a.p. X-ray path when pulling outwards, Right angle of the foot, 40 ° internal rotation of the Lower leg and 45 ° caudo-cranial X-ray a talo-calcaneal tilt with medial displacement Exercise of the calcaneus in the sense of subtalar instability can be demonstrated. 10. Universal holding device for the upper and lower jump joint according to one of the claims 1-9 characterized, that in the a.p.-X-ray path at 45 ° tilted foot with 25 ° internal rotation and 25 ° cranio-caudal tilt X-ray tube a calcaneo-cuboidal tilt in the sense the instability of the anterior lower ankle can be demonstrated.