US20020099379A1

US20020099379A1 - Locking nail for the repair of femur shaft fractures

Info

Publication number: US20020099379A1
Application number: US09/560,716
Authority: US
Inventors: Michael Adam
Original assignee: Zimmer GmbH
Current assignee: Zimmer GmbH
Priority date: 1999-05-12
Filing date: 2000-04-27
Publication date: 2002-07-25
Anticipated expiration: 2020-04-27
Also published as: US6461360B1; DE50015249D1; ATE400228T1

Abstract

The locking nail for the repair of femur shaft fractures, also in connection with trochanteric femur fractures, comprises a proximal nail section (2) and a distal nail section (3) adjoining the latter, with the nail sections (2, 3) having bores (2 e, 2 f, 2 h, 2 i, 3 a, 3 b, 3 c) for the reception of bone screws, and with the distal nail section (3) having a curvature extending in an anterior-posterior plane (apE) and corresponding substantially to the antecurvature of the femur, with the proximal nail section (2) having at least over a partial section (2 a, 2 b) a continuous curvature, in particular with constant radius of curvature (R2), extending in a lateral-medial plane (lmE).

Description

The invention relates to a locking nail for the repair of femur shaft fractures, also in connection with trochanteric femur fractures, in accordance with the preamble of claim 1.

An osteosynthetic aid for the repair of intertrochanteric or subtrochanteric femur fractures which is designed as a locking nail with an open cloverleaf profile is known from the reference EP 0 528 128. The locking nail has inclined bores in its proximal section for guiding and holding a femoral neck screw. The locking nail has an axial longitudinal slit at its distal section. The locking nail also has a bend at the transition between a proximal partial section and a distal partial section. Disadvantageous in this known locking nail is the fact that it is difficult to introduce into the medullary space.

The object of the present invention is to create a more advantageous locking nail for the repair of femur shaft fractures.

This object is satisfied by a locking nail having the features of claim 1. Subordinate claims 2 to 13 relate to further, advantageous embodiments of the locking nail in accordance with the invention.

This object is satisfied in particular by a locking nail comprising a proximal nail section and a distal nail section adjoining the latter, with these nail sections having bores for the reception of bone screws, and with the distal nail section having a curvature extending in an anterior-posterior plane and corresponding substantially to the antecurvature of the femur; and with the proximal nail section having at least over a partial section a continuous curvature, in particular with constant radius of curvature, extending in a lateral-medial plane.

The term “continuous curvature” will be understood in the following to mean that the curvature has no point with a discontinuity or a bend respectively, which can be mathematically described in such a manner that the first derivative of the curvature plot has no discontinuity or no jump-like change.

In an advantageous embodiment the proximal nail section, starting from the distal nail section, has a transition section and a securing section adjoining the latter with bores for the reception of the bone screws, with the transition section and the securing section having a continuous curvature with a constant radius of curvature.

The locking nail in accordance with the invention is suitable in particular for the repair of femur shaft fractures, also in connection with trochanteric femur fractures, with the locking nail being manufactured with lengths of about 300 mm to 500 mm due to the inter-individually differing shaping of the femur. The locking nail is distinguished by a good mechanical hold in the medullary cavity and has a good rotational security. A transverse bore through which a bone screw is introduced in order to firmly hold the locking nail axially and in the direction of rotation is arranged in the lower distal nail section. The proximal nail section preferably has an inclined through-bore through which a femoral neck screw can be introduced.

The locking nail in accordance with the invention is preferably designed as a continuous hollow tube, in particular as a cylindrical hollow tube and consists of a body-compatible, non corroding material such as titanium or a titanium alloy. A guide wire is preferably introduced into the continuous hollow tube. The locking nail could however also be designed in the shape of a bar and have no hollow inner space extending in the axial direction.

An advantage of the locking nail in accordance with the invention is the fact that the latter can be introduced into the medullary space of the femur without a greater exertion of force even in an embodiment with low elasticity. The embodiment with low elasticity ensures a very good mechanical hold and a good support function in the medullary cavity.

The locking nail in accordance with the invention is designed in such a manner that the latter is preferably introduced into the femur or into its medullary space respectively starting from the trochanter major, with the introduction point being located slightly laterally with respect to the tip of the trochanter major. Since the trochanter major is arranged closer to the surface of the skin in comparison with the previously usual introduction location at the femur, the introduction via the trochanter major has the advantage that a smaller opening of the operation field is required, which in particular reduces the danger of infections. In addition the trochanter major is more easily accessible in the activities required during the operation. A locking nail was usually introduced into the medullary space in the region of the fossa piriformis. Blood vessels etc. are also present at this location, however, so that the introduction via the trochanter major is more sure to avoid damage to these blood vessels. In an advantageous embodiment the locking nail has a securing section with a relatively small cross-section. This enables a locking nail to be formed with a smaller total cross-section, which has an advantageous effect on the introduction into the medullary space and in addition requires only a small opening of the operation field.

The locking nail which is known from the cited reference has at the transition location between the distal and the proximal nail section a bend location and is therefore difficult to introduce into the medullary space in spite of the elasticity produced by the longitudinal slit in the distal nail section since the medullary space has a curved extent and this nail lies in contact at certain locations at the medullary space wall or at the spongiosa and can be introduced into the medullary space only with a greater exertion of force. The locking nail in accordance with the invention with the curved proximal nail section has the advantage that the latter takes into account the anatomical shape of the medullary space in such an advantageous manner that it can be introduced without a greater exertion of force. In contrast to short locking nails, the locking nail in accordance with the invention, which is designed to be very long, must be rotated during the introduction into the medullary space by a partial rotation about its longitudinal axis. The locking nail in accordance with the invention has the property that the latter rotates into the correct final position by itself during the introduction into the medullary space since the outer shape of the locking nail is formed in imitation of the shape of the medullary space with respect to essential aspects. The locking nail which is known from the cited reference has a bend at the transition location between the proximal and distal nail section, which prevents a rotation of its own accord during the introduction into the medullary space. The locking nail which is known from the cited reference has the further disadvantage that the nail which is introduced into the medullary space is only rotatable to a limited extent since material protrudes into the longitudinal slit and forms an obstacle during the rotation. Since the locking nail in accordance with the invention does not necessarily require a longitudinal slit, it can also be manufactured more economically.

The locking nail in accordance with the invention can have a low elasticity and nevertheless be surely introduced without a greater exertion of force into the medullary space. Through the design of the locking nail in accordance with the invention a greater force, which is directed approximately radially outwardly and in particular weakens or destroys the femur corticalis, is avoided during its introduction into the medullary space. Through this it is also enabled that the femur is held together in its anatomically correct position. It is known that an unfavourably designed locking nail can cause the femur having the fracture to adapt to the shape of the locking nail, which has the result that the fixed femur has a faulty position or a deviation from the normal position respectively.

Exemplary embodiments of the locking nail in accordance with the invention will be explained in the following in more detail with the help of the drawings. Shown are: [0014]
FIG. 1 a side view of the locking nail from the direction B; [0015]
FIG. 2 a front view of the locking nail from the direction A; [0016]
FIG. 3 a front view of the locking nail, which is rotated slightly about its axis, from the direction C, partly in section; [0017]
FIG. 4 a detail view of the proximal nail section from the direction D; [0018]
FIG. 5 a detail view of the locking nail from the direction E; [0019]
FIG. 6 a cross-section through a slit locking nail; [0020]
FIG. 7 a detail view of the securing section from the direction F.[0021]
The [0022] locking nail 1 in accordance with FIG. 1 is formed in a single piece and consists of a proximal nail section 2 and a distal nail section 3 adjoining at the latter. Starting from the proximal end 1 a of the locking nail 1 the proximal nail section 2 comprises a thread section 2 c extending in a straight line and having an inner thread 2 d, adjoining thereat a securing section 2 b which has a transverse bore 2 i, an oval transverse bore 2 h and two inclined bores 2 e, 2 f, and adjoining thereat a transition section 2 a which extends conically contracting to the distal nail section 3. The surface of the securing section 2 b has a groove 2 g extending parallel to the inclined bores 2 e, 2 f. Depending on the fracture, bone screws can be introduced into the inclined bores 2 e, 2 f and/or the groove 2 g in order to secure the femur head. For this purpose an aiming device or a hammering-in tool is preferably used which is temporarily screwed into the inner thread 2 d of the thread section 2 c when the locking nail 1 is inserted into the femur in order to be able to screw in the bone screw with an exact guidance.
Adjoining at the [0023] transition section 2 a the distal nail section 3 extends up to the distal nail end 1 b. The centre line 1 c which extends in the middle of the locking nail 1 is illustrated between the proximal nail end 1 a and the distal nail end 1 b. The anterior-posterior plane apE extends corresponding to the plane of view in accordance with FIG. 1. The distal nail section 3 has a curvature which extends in this anterior-posterior plane apE and which is substantially designed corresponding to the antecurvature of the femur. The curvature of the distal nail section 3 or of its middle line 1 c is preferably designed as a circular segment, with the radius of curvature R1 amounting to for example 2 meters depending on the anatomical form of the femur. Transverse bores 3 a, 3 b, 3 d and an oval transverse bore 3 c are placed in the distal nail section 3 for the reception of bone screws.
In FIG. 1 the lateral-medial plane lmE, which extends perpendicularly to the plane of view or to the anterior-posterior plane apE respectively, is also illustrated. The lateral-medial plane lmE extends corresponding to the plane of view in accordance with FIG. 2. In FIG. 2 the anterior-posterior plane apE, which extends perpendicularly to the plane of view or to the lateral-medial plane lmE, is also illustrated. [0024]
The front view of the [0025] locking nail 1 from the direction A in accordance with FIG. 2 shows the distal nail section 3, which extends in a straight line in the lateral-medial plane lmE from this point of view and at which the two, the transition section 2 a and the securing section 2 b, having a common curvature with a constant radius of curvature R2, adjoin. The following thread section 2 c is designed in the illustrated exemplary embodiment to extend in a straight line, but could however also be designed to extend curvilinearly and in particular have the same radius of curvature R2. The partial section 2 a, 2 b or, respectively, the centre line 1 c which extends in the lateral-medial plane lmE, has a constant radius of curvature R2 and extends in the axial direction at least over about a fourth of the total length of the locking nail 1, and preferably over about a third of its total length.
The detail view illustrated in FIG. 4 from the direction D shows a part of the [0026] proximal nail section 2, namely the securing section 2 b and the thread section 2 c. In the securing section 2 b the openings of the first and second inclined bore 2 e, 2 f, the notch 2 g and a part of the oval transverse bore 2 h can be seen. In addition the proximal nail section 2 has two notches 21 at the proximal nail end 1 a. The notches 21, the inclined bores 2 e, 2 f and the oval transverse bore 2 h all extend in the same plane S2. As can be seen in FIG. 3 the centre lines 2 m, 21 of the inclined bores 2 e, 2 f extend parallel to one another, with the notch 2 g also extending parallel to the inclined bores 2 e, 2 f in FIG. 4. In further exemplary embodiments the inclined bores 2 e, 2 f could also extend not parallel to one another.
FIG. 7 shows a plan view from the direction F onto a segment of the securing [0027] section 2 b with inclined bores 2 e, 2 f and notch 2 g, with the direction F extending parallel to the centre lines 2 m, 21. A screw 6 with a centre line 2 n is arranged in the ventrally arranged notch 2 g. In the illustrated exemplary embodiment the centre lines 2 m, 21, 2 n are spaced to form an equilateral triangle, with the centre lines 2 m, 21 extending through the centre line 1 c of the locking nail 1. The distance between the centre lines 21, 2 n and the centre lines 2 m, 2 n amounts for example to 8 mm. The proximal nail section 2 is firmly connected to the femur by one, two or three screws 6 which are arranged to pass through the two inclined bores 2 e, 2 f and the notch 2 g. This arrangement of two inclined bores 2 e, 2 f and of the notch 2 g has the advantage that the diameter of the proximal nail section 2 can be designed relatively thin and nevertheless a secure anchoring of the locking nail 1 by means of bone screws 6 is possible. The locking nail 1 can for example be designed in such a manner that the proximal nail section 2 has a diameter between 13 and 15 mm and the distal nail section 3 has a diameter between 9 and 13 mm. A locking nail 1 which is designed to be so thin has the advantage that it requires only a small opening of the operation field for its implantation. Thus a lower danger of infection is present during the implanting due to the small skin opening required. The securing section 2 b with inclined bores 2 e, 2 f and ventrally arranged notch 2 g, in particular in accordance with the embodiment illustrated in FIG. 4 and FIG. 7, could also be used separately from the other parts 2 c, 2 a and the distal nail section 3 in a differently designed locking nail. A securing section 2 b of this kind could also be designed to extend in a straight line or curvilinearly respectively in the axial direction. FIG. 5 shows a front view of the proximal nail end 1 a from the direction E. Starting from the proximal nail end 1 a the locking nail 1 extends along the proximal nail section 2 in a left curve and extends after the transition to the distal nail section 3 in a downwardly pointing curve. A plane S1 extending in the direction of view perpendicularly through the distal nail section 3 and the plane S2 extending through the notches 21, the inclined bores 2 e, 2 f and the oval transverse bore 2 h intersect at an angle of 78 degrees. The proximal nail section 2 thus has an anteversion of 78 degrees with respect to the distal nail section 1. This anteversion is required in order that the inclined bores 2 e, 2 f and the transverse bore 2 h respectively extend in the direction of the femur neck or of the femur head respectively when the locking nail 1 is inserted in the femur. The anteversion amounts preferably to between 75 degrees and 80 degrees, depending on the anatomical form of the femur. The German term “Antetorsion” is called “anteversion” in English.
FIG. 3 shows the locking [0028] nail 1 from the direction of view C, which extends perpendicularly to the plane S2. Relative to the illustration in accordance with FIG. 2 from the direction of view A the locking nail 1 is illustrated in accordance with FIG. 3 to be rotated by 12 degrees about its longitudinal axis. The plane of intersection through the proximal nail section 2 corresponds to the plane S2 and extends parallel to the plane of view.
FIG. 6 shows a section through a further exemplary embodiment of a [0029] distal nail section 3 having a gap 5 which extends in its longitudinal direction in order to lend a higher elasticity to the nail section 3.
The locking [0030] nail 1 illustrated in FIGS. 1 to 5 is intended for a left femur. As a result of the physiological antecurvature and anteversion of the femur a right and left version of the locking nail 1 are required.

Claims

1. Locking nail for the repair of femur shaft fractures, also in connection with trochanteric femur fractures, comprising a proximal nail section (2) and a distal nail section (3) adjoining the latter, with the nail sections (2, 3) having bores (2 e, 2 f, 2 h, 2 i, 3 a, 3 b, 3 c) for the reception of bone screws, and with the distal nail section (3) having a curvature extending in an anterior-posterior plane (apE) and corresponding substantially to the antecurvature of the femur, characterised in that the proximal nail section (2) has at least over a partial section (2 a, 2 b) a continuous curvature with constant radius of curvature (R2), extending in a lateral-medial plane (lmE).

2. Locking nail (1) in accordance with claim 1, characterised in that the partial section (2 a, 2 b) having a continuous curvature in the axial direction extends at least over about one fourth of the total length of the locking nail (1), preferably over about one third of the total length.

3. Locking nail (1) in accordance with any one of the preceding claims, characterised in that the proximal nail section (2), starting from the distal nail section (3), consists of a transition section (2 a), a securing section (2 b) adjoining the latter and a thread section (2 c) adjoining the latter; in that the securing section (2 b) contains bores (2 e, 2 f, 2 h, 2 i); and in that at least the transition section (2 a) and the securing section (2 b) have a common curvature with a constant radius of curvature (R2).

4. Locking nail (1) in accordance with any one of the preceding claims, characterised in that the proximal nail section (2) has at least one inclined bore (2 e, 2 f).

5. Locking nail (1) in accordance with claim 4, characterised in that the proximal nail section (2) has at its surface at least one notch (2 g) which extends substantially parallel to the at least one inclined bore (2 e, 2 f).

6. Locking nail (1) in accordance with claim 5, characterised in that the notch (2 g) is arranged to extend ventrally.

7. Locking nail (1) in accordance with any one of the claims 4 to 6, characterised in that the inclined bores (2 e, 2 f) extend parallel to one another.

8. Locking nail (1) in accordance with any one of the claims 4 to 7, characterised in that two inclined bores (2 e, 2 f) and a notch (2 g) are arranged to extend parallel to one another and in particular to form an isosceles or equilateral triangle.

9. Locking nail (1) in accordance with any one of the claims 3 to 8, characterised in that the thread section (2 c) is designed to extend in a straight line and runs out to the proximal nail end (1 a), with the thread section (2 c) having an inner thread (2 d) for the reception of an aiming device or a tool for hammering in or out.

10. Locking nail (1) in accordance with any one of the preceding claims, characterised in that the bores (2 e, 2 f, 2 h, 2 i) are arranged to extend in the proximal nail section (2) in such a manner that their axes have an anteversion (a) of 75 degrees to 80 degrees, and in particular an anteversion (α) of 78 degrees, relative to the distal nail section (3).

11. Locking nail (1) in accordance with any one of the claims 3 to 10, characterised in that the transition section (2 a) conically contractingly merges from the securing section (2 b) to the distal nail section (3).

12. Locking nail (1) in accordance with any one of the preceding claims, characterised in that the latter is designed as a hollow tube.

13. Locking nail (1) in accordance with any one of the preceding claims, characterised in that the hollow tube has a slit (5) extending in the axial direction in the distal nail section (3).