US 2675801 A
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Ap i 1954 J. BAMBARA ET AL INTRAMEDULLARY NAIL 2 Sheets-Sheet 1 Filed Dec. 17, 1952 INVENTORS. (Z0422 Bamara 7 BY Maine? 7. Mod y ATTORNEY April 20, 1954 J. BAMBARA ETAL 2,675,801
' INTRAMEDULLARY NAIL Filed Dec. 17, 1952 2 Sheets-Sheet 2 IN V EN TORS' ATTORNEY Fatentecl Apr. 20, 1954 NITED STATES TENT OFFICE IN TRAMEDULLABY NAIL John Bambara, Bloomfield, and Michael T. Modny, Glen Ridge, N. J.
Our invention relates generally to nails used in bone surgery and specifically to intramedullary nails having provision for manipulation after insertion in a bone cavity.
It is among the objects of our invention to provide an intramedullary nail which is easy to insert.
It is a further object of our invention to provide an intramedullary nail which may be inserted into the broken end of a bone and manipulated through a single window cut in the bone; it does not require supplemental or additional windows for its insertion, and when it is in place, it is wholly within the bone and no portion of its protrudes therefrom.
It is yet a further object of our invention to provide an intramedullary nail which does not migrate, but remains fixed in place.
It is yet another object of our invention to provide an intramedullary nail which may be manipulated through a single window until it assumes its proper place in the bone.
I'hese objects and advantages, as well as other objects and advantages, may be achieved by the device illustrated in the appended drawings, in which:
Figure l is a view in perspective of a part of our intramedullary nail;
Figure 2 is an end view thereof;
Figure 3 is a side view thereof;
Figure 4 is an edg view thereof;
Figure 5 is a View of a broken bone with our intramedullary nail in the first stage of insertion through the broken end of one part of the bone;
Figure 6 is a view showing our intramedullary nail completely swallowed by one part of the broken bone and with the other part of the bone in alignment to receive the nail; and
Figure 7 is a View showing our intramedullary nail moved into its final position extending substantially equally into the bon at each side of the break.
In the treatment of broken bones it has in the past been the practice in some instances to brin the bones into alignment through the use of a nail inserted into the soft center of the bone. Such insertion usually takes place by drilling a hole in the end of the bone and forcing the nail into the interior bone until it extends beyond the point of break and one either side of it. In forcing the nail into the bone in this manner, it is frequently found a difficult thing to cause the entry of the nail into the bone. Furthermore, an incision may be made near the point of the break to control the proper entry of the nail into the other portion of the bone and to insure perfect alignment. Thus, two incisions may b necessary. Since nails are frequently disposed with their ends only a short distance away from the end of the bone, a movement of the nail may cause a migration or extrusion of the nail beyond the endof the bone, and it may actually be extruded through the flesh.
We have discovered that it is possible to devise a nail which may be inserted through the broken end of the bone and manipulated through a single incision; such an insertion may be easily accomplished; the nail may be easily manipulated into place; once in place it will not migrate; and further only a rather small nail is usually necessary.
Referring now to the drawings in detail, it will be seen that our nail consists of a rod-shaped body member ll having a plurality of fins [2 extending therefrom. The exact number of fins may be a matter of choice. In the preferred form, shown in Figures 1 to 4 inclusive, however, four fins extend from the rod. The nail, therefore, is cruciform in cross-section. It is preferred that the fins l2 b disposed at an angle of degrees to each other. Transverse to the longitudinal axis of the nail and perpendicular to that axis, a plurality of holes H5 at regular intervals are bored through the rod H. These holes are perpendicular to the central axis of the rod member and coaxial with a line bisecting the angle between the adjacent ribs.
The use of our nail is illustrated in Figures 5 to 'I. A broken bone ll, I8 is presented. If there is comminution, the extra pieces may be secured to the main portion of the bone by screws. The next step in preparing the bone for the use of our nail is fenestration. Immediately adjacent to the broken end of the bone, a small window i9 is bored or out into the center of the bone. The center of the bone ll, it may be of soft consistency and have a cavity of such dimensions that it will readily receive our nail. However, if this is not the case, then the center of the bone may be reamed to such a degree as to receive our nail l l. When this has been done, then the nail H is inserted into the center of the bone until it is completely encompassed by the bone ll, it. This may be done by applying pressure to the end of the nail l l to drive it all the way in; or by exerting leverage on the nail through the window l9 by inserting the lever 2E9 through the window It cut in the bone ll, l8 and engaging it with the holes l 3, l3 successively in the nail. Thus by using the edge of the window is as a fulcrum for the lever 20, the nail may be manipulated into and completely swallowed by one end ll of the bone and caused to enter it entirely. Thereupon, the other broken end I8 of the bone is brought into precise alignment with the first end I! of the bone into which the nail has been inserted. Then the lever 20 is inserted into the window [9 in the bone l1, l8 and by using the edge of th window I9 as a fulcrum, the nail l I is caused to advance from one end l1 into the other end iii of the bone. When, by the action of the lever, the nail has been advanced to such position that it is approximately equally extensive into both ends of the bone ll, IE, it may be locked in this position by causing a screw to penetrate the bone and into one of the holes in the nail. The fins I2 have passed through the soft, spongy marrow in the center of the bone and engage the more dense outer walls of the bone. Rotation of the fragments of the bone is thereby prevented. The operation is then complete and the incision in the flesh may be closed in the usual manner.
It will be seen that by following our procedure, and using our nail II, M it is only necessary to make a single incision at the point where the bone is broken. The reaming of the center of the bone and the cutting of the window IS in the bone may be simply accomplished through this single incision. It is also easy to insert our nail through the single incision and to manipulate it both into and out of the bone by the lever 20. Since the joint end of the bone has not been cut open for the purpose of. admitting a nail l I, 14, there can be no migration of our nail. Furthermore, the holes permit of the locking of the intramedullary nail in place by a screw so that no movement whatsoever of the nail is possible. In addition to that, our, intramedullary nail may be much smaller than the conventional intramedullary nail which is merely a piece of metal with arcuat crosssection.
The foregoing description is merely intended to illustrate an embodiment of the invention. The
component parts have been shown and described. They each may have substitutes which may perform a substantially similar function; such substitutes may be known as proper substitutes for the said components and may have actually been known or invented before the present invention; these substitutes are contemplated as being within the scope of the appended claims, although they are not specifically catalogued herein.
1. An intramedullary nail comprising a rodshaped member having a substantially cruciform cross section and with a plurality of transverse passages therein.
2. An intramedullary nail comprising a rodshaped member having a substantially cruciform cross section and with a plurality of transverse passages extending therethrough transverse to the longitudinal axis of the member.
3. An intramedullary nail comprising a rodshaped member having a substantially cruciform cross section and with a plurality of transverse passages extending therethrough equidistant from each other and transverse to the longitudinal axis of the member.
References Cited in the file of this patent UNITED STATES PATENTS Number Name Date 2,614,559 Livingston Oct. 21, 1952 2,620,792 Cordasco Dec. 9, 1952 FOREIGN PATENTS Number Country Date 118,595 Sweden Apr. 15, 1947 OTHER REFERENCES The Journal of Bone and Joint Surgery for July 1951, pp. 659-451. Copy in Div. 55.
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