US2518019A - Intramedullary splint - Google Patents

Description

g- 1950 J. T. KANE INTRAMEDULLARY SPLINT Filed Nov. 29, 1946 INVENTOR FIG. 4

FIG 5 JOHN T. KANE B%(MJW ATTO R N EY Patented Aug. 8, 1950 -isrAr-ns PATENT- 1= I f 2,318,019 v I I I WTB MEDULLARY SPLINT T r o ir- ;Binghamtdirjn. Y.

" I Atr iicatio'n November 29, i946, Serial No. 712,915 .01551 c 2 V My -inventiim relates oi'an improvedintrm medullary splint for use inthe treatment of fractured limbs, and it will be described herein'as' it is preferably made-andused by me in the care of T patients suffering from; a diaphyseal fracture or fractures of'the femur. i J I *f-'; Intra'r'ne'dullary splints; 'of a U or V sha'pe in cros'sfsection have beenused'for a considerable length-0f time in the "care of patients suffering from fractures, including fractures or the femur, Such splints have had, general; several dis advantageous features' or characteristics. 1 For example, thepreviously used splints have; been straight lengthwise, and have not beenshaped complementaryj fthe anteroposterior and lateral bowing ofthe'medullary cavityfin the manner required to give the 'niaxii'r vgrri amount vof support-to" the fractured bone" at the fracture site. 'Also', the same failure to shape the splint in: accordance f with the" anteroposte'rior. andf'lat eral v bowing of the medullary cavity; has ,made it extremely fdifiicult for the attending surgeon in some cases to be certain that the fractured bone fragments are properly aligned, and in such cases misalignment'has' frequently resulted, with all; of its attendant 1 serious fco lfieqliences. Further'; because" of the' 'f lure 'tol shape 'suclf splints complementary to the, owing of themedullary cavity, it has been impossible to insert the splints in the'lower third offthe' mediillary cavity to make suchsplints'of usejin the treatment of fractures in 'the lower third of theifemuru In the in'sertion of "the prior art, 'straight splints, frequent driving of the, lower end,of,..the fsp1int into the boneihas occurred/.51

' Another seriouslldisfadvaritage of the previously known intramedull'a'ry splints is that they have not'sufficiently filled the cavity, thus permitting relative movements between the fractured bone segments themselves, aswell as'relative movements between, the. fractured bone segments and thesplint, In the case of the first mentioned relative movements, union-of the bone fragments is prolonged, and .the,fragments do not necessarily in proper aligmn nt and position. In thefcase of relative movements betweenthe' bone fragments and the splint, the splint may retain the displaced bone fragments I :in an improper position, thereby. promoting union-of the bone fragments a misaligned position.

still another undesirable, feature of the prior artintramedullary, splints is thatthey have not gripped the bone fragments with sufiicient cerlelntm Prevent, ,lateralrotation. er..-the: 1m-

ments, resulting; in delayed and ,improperly aligned union.

Also, the U -shaped splints knownto the prior art have an additional disadvantageous feature in that a large area of the splint contactstthe wall, of the cavity, cutting 01f minimal circulalion inthe-area of contact.

The general object of my invention is to provide an .intramedullary splint. which; does not have the outlined disadvantages of the previously known intramedullary splints, and which will, use, facilitate the locating of the bone frag mentsjby the attending surgeon in their proper positions, in all respects, and which will hold the bone fragments in such position until "unmn is completed'and the splint is withdrawn. I Another object of my invention is to provide a simply constructed, easily insertable and easily removable intramedullary splint which'will' not irritate the body in any manner while inserted therein.

' Qther objects and advantages of my invention will become apparent upon a reading ofthe folglowing disclosure. g

I 5 In order that the preferred embodiment of my invention may be clearly understood, reference is made-to the accompanying drawing, showing a preferred embodiment thereof, whereinf Fig.-1 is-a partial cross-sectional anterior view of the femur of the left leg, showing the improved inserted in the medullary cavity thereof. p

Fig. 2 is a partial cross-sectional lateral view of the'same elements as shown in Fig.1,- as seen from the left side of the femur. a Fig. 3 is a sectional view, taken along the plane III -III- of Fig. 2. p Y Fig 4 is a sectional view, taken alongthe plane IV--IV of Fig. 2, and I Fig; 5 is a sectional view, taken along the plane v' v of Fig. 2. Referring now to Fig. 1, the left "femur is shaped, as seen anteriorly, as shown, the femur being numbered ID. A fracture is designated ll. The head of the femur l2 and condylar region 14 are shown, as is the medullary cavity which is designated Hi; It will be noted that this cavity extends from the area of the insertion of inferior gemelli muscles [8 to the supra-condyle 20, near the lower end thereof. As shown in the anterior view, the medullary cavity I6 is slightly bo'wed, the upper and lower ends being displaced'outwardly or to the right, of the central por'tio'nof the cavity; Further, the cavity tapersfrom "a larger-diameter at the top thereof to a; smaller diameter about one-third of the distance down the femur; the cavity then maintains a fairly constant diameter during the middle third of its extension; and then the cavity gradually increases in diameter for the remaining third of its extension.

Referring now to Fig. 2, the left femur is shaped, as seen from the left side thereof, as shown in outline. The head of the femur l2 and condylar region [4- are shown; as is themedullary cavity [5. The anteroposterior bowing of the cavity will be seen to be greater than the. lateral bowing which was previously described in" In Fig. 2 itlwill -be. seen that the upper and lower ends of the cavity are,

connection with Fig. 1.

located posteriorly of the middle portion thereof. Insofar as the size of the. cavity-is concerned, when seen as viewed in Fig. 2, the cavitytapers from a larger diameter. at the top thereof to a smaller diameter aboutone-third of the distance down the femur; the cavity then maintains a fairly constant diameter during themiddle third of its extension; and then the cavity gradually increases in diameter in the lower third of its extension. I

Referring again to Fig. 1, there isshown inserted in the medullary cavity l-S a'splint made in accordance with the principles of my invention. This splint includes an elongated main body 22, a lower pointed end '24, a pin 26 affixed to the upper end of the elongated body 22, and a ball 28 affixed to the upper end of this pin. In Fig. 4 it will be seen that'the'body portion 22 ofthe splint is four-sided andgen'erally' square in cross section, and is preferably of tubular metal construction, to impart strength as well as lightness thereto. To thelower end of thembular body portion is aflixed a plug 24, also pref erably four-sided, to conform to t emes of the main body portion. The lowermost end of this plug is preferably pointed, as shown, and this plug may be aflixedto the main body portion in any suitable manner, or may be formed integrally therewith. 7

At the upper end of the body portion .22, as seen in Fig. 3,-is provided theplug 39, whichmay be affixed to the body 22 in any suitable method, or may be formed integrally therewith. Carried by plug is the pin 26 to which is affixed the metalball 28. v v

Referring now to Figs. 1 and 2, itwill .be seen in both views that the elongated body portion 22 is of greater width at the top and tapers gradually throughout the upper third of its. extension, and-is. more or less constant. in Width throughout its lower two-thirds of length, If desired, however, thelower third of the splint maybe tapered to a lesser width than the middle thirdthereof. The width of the splint at any. placein' the approximate upper tWo-thirds thereof issuch' that when the splint is driven into place,;=;as., shown inFigs. l and 2, the four cornersv of thesplint will firmly engage the inner wallof the bone which forms the medullary cavity.

n Fig. 1 a will be seen that the body 221s slightly bowed, its upper and lower ends being displaced outwardly or to the right, of the central portion thereof. Accordingly, the splint22 is bowed medially complementary to the medial bowing of the medullary cavity... In Fig. 2, the anterior bowing of the splint is more accentuated thanthe medial bo-wingin Fig. l, and-wis bowed complementary to the anterior bowing-of the ;f'orej the operation. The affected extremity is adduct'ed and" internally rotated. If a method of traction is available for use on the affected I limb, such a procedure should be exercised.

vertically, thehip joint may be readily exposed.

The gluteus maximus muscle is divided, and the gluteus medius muscle is incised at the point of its insertion. The finger may then be introduced into the niche which is'foccupied by the inferior gemelli muscles; anda-l/z" drill hole; may be made at this site, and the marrow cavity readily exposed... Atthe'sa-me time, arr incision is made over the fracture site and the-fragments. are approximated using ja bone clamp to hold them together. By means of aqhammer the splint is driyen into the marrow cavity and across the fracture ,site to the' position shown in the drawings..- The wound is. then closed at both the fracture site, and at the point of introduction of the. splint... The g-luteus medius. is re-sutured at the pointof insertion; the gluteus maximus is approximated,:and the.- skin is closed with silk. .The open method ,of operation allows the surgeonto place the splintin an extra capsular positifon,.thus.avo iding. the introduction of infection into thehip joint. proper.

The splint. mayberemovedafter the bone fragments have. sufficiently. unitedthrough an in icision ov'er,theItuberosity on the affected side. Lubrication-"of the 'medullary cavity. will facilitate extraction. 'Theprovision of the ball 28, which may be. grasped by asnitable instrument, 'a'ssuresfleasy removallof' the splint.

By virtue of the compound bowing of the splint, as well as thefclescribe'd tapering thereof, i'tjwill be appreciated that the splint. of this invention establishe a proper. reference with res'pect'to'wh'ich thebqne fragments may he properly 'approximatfedby'the'attending surgeon, so that perfect apposition ofthe fragments may be had. ,"The square, tapered"spl'i11t assures en- 'gag'ement ofthe splintfat each of itsv four corners for at'jlfea'stftwo-tl' irds the length of the splint witl'tthe interior of the bone fragments.

The bone fragments are held in proper position, thus'preventing 'latera'hrotation of the frag- Liateral -rotatiom-is most apt tooccur in the case of fractures in the upper two-thirds" of'the femur and-results fromthe action of the iliopsoas' muscles arid external rotators of the hip tend to turnthenpper bonefragment when the-*patient is walking. Clearly; by the use of my splintthe upper and lowerfragm'ents are heldiii-position relativeto' one another toprevent any relative l'ateral r 'otation between the upper and lower fragmentsr :In the case-offractures of the lower third ofthef'em ur; the -musc-les inserting at the lower end of the femur-tend topull the lower fragment posteriorlywith resultant anterior displacement 'of the upper fi'agmentresulting in the formation of en angle-between the two fragments. Also,

medullary cavitylfi. .It will be notedthat the w theends of the bene fragments may slidepast one 5. another. In either case, shortening of the bone and leg results. By the provision of a splint bowed complementary to the medial and anteroposterior bowing of the medial cavity, it is possible to drive the lower end of the splint into the lower end of the cavity, thus minimizing the danger of such displacements.

The main body portion of the splint is preferably completely within the medullary cavity, and

the pin 26 and ball 28 are the only portions of the splint outside the cavity. By virtue of this arrangement the corners of the splint grip the bone fragments to hold them in proper juxtaposition, and the smooth surfaces of the pin 26 and ball 28 will not irritate the muscles of the patient nor the neighboring joint capsule, thus diminishin greatly the dangers of infection in the hip joint and surrounding muscles.

The completely enclosed splint prevents secretions from the body leaking into the splint, and the plating of the splint with vitalium or tantalum prevents any corrosion of the splint, or resulting infection. Because the splint engages the interior of the bone only along the four edges of the splint, minimal circulation is permitted through most of the area of the cavitywall.

Not only does the use of my splint assure the retention of the bone fragments in proper position while union is taking place, but the retention of the fragments in such position, in continuous contact with the adjoining fragment or fragments greatly facilitates early union of the fragments. Earlier ambulation of the patient is possible, not only resulting in a psychological uplift to the patient, but also lessening the danger of complications, such as hypostatic pneumonia,

urinary infection, urinary calculi, etc., resulting fromkeeping the patient in bed for a longer period of time. Physiotherapy may be begun at an earlier time, and muscular atrophy will be minim'al. Also, earlier massage and ambulation will prevent stiffness of the knee on the affected side.

Certain of the improved features of my invention may be utilized in the construction of other types of splints. Also, it will be appreciated by those skilled in the art that changes may be made in the disclosed preferred embodiment of my invention without parting from the substance thereof. All such uses and changes are intended to be covered by the following claims.

I claim:

1. An intramedullary splint for use in the treatment of fractures of the femur comprising an elongated member bowed medially and anteroposteriorly corresponding to the medial and'antero-posterior bowing of the medullary cavity of the femur, the upper end portion of said splint being tapered from a greater size at the upper end thereof for a substantial portion of the length of the same, and the adjoining portion of said splint being of substantially constant width for a substantial portion of the length thereof.

2. An intramedullary splint for use in the treatment of fractures of the femur comprisin an elongated member bowed medially and anteroposteriorly corresponding to the medial and antero-posterior bowing of the medullary cavity of the femur, the upper end portion of said splint being tapered from a greater size at the upper end thereof for a substantial portion of the length of the same and the adjoining portion of said splint being of substantially constant width for a substantial portion thereof, the outermost portions of said member comprising a plurality of generally parallel, relatively narrow and circumferentially displaced surfaces for gripping the walls of the medullary cavity.

3. An intramedullary splint for use in the treatment of fractures of the femur comprising an elongated four-sided tubular member substantially square in cross-section, a pointed plug held by the lower end of said member, a plug in the upper end of said member, a pin held by the last mentioned plug, and a ball held by the upper 3 end of said pin, the said elongated member being bowed medially and antero-posteriorly corresponding to the medial and antero-posterior bowing of the medullary cavity of the femur.

4. An intramedullary splint for use in the treatment of fractures of the femur comprising an elongated four-sided tubular member substantially square in cross section and tapered from a greater size at the upper end thereof for a substantial portion of the length of the same, a pointed plug held by the lower end of said member, a plug in the upper end of said member, a pin held by the last mentioned plug, and a ball held by the upper end of said pin, the said elongated member being bowed medially and antero-posteriorly corresponding to the medial and antero-posterior bowing of the medullary cavity of the femur.

5. An intramedullary splint for use in the treatment of fractures of the femur comprising an elongated tubular member bowed medially and antero-posteriorly corresponding to the medial and antero-posterior bowing of the medullary cavity of the femur, said member being tapered from a greater size at the upper end thereof for a substantial portion of the length of the same, corresponding to the tapering of the medullary cavity of the femur, a pointed plug held by the lower end of said member, a plug in the upper end of said member, a pin held by the last mentioned plug, and a ball held by the upper end of said pin, the outermost portions of said tubular member comprising a plurality of generally parallel, relatively narrow and circumferentially displaced surfaces for gripping the walls of the medullary cavity.

JOHN T. KANE.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS OTHER REFERENCES Lenclouage medullaire des fractures diaphysaires, by Robert Soeur, in Scalpel, No. '15, August 1944, published by the Surgical Service of the Hospital St. Pierre, Brussels, Belgium.

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