WO1982003983A1

WO1982003983A1 - Additional surgical table usable for the extension and reposition

Info

Publication number: WO1982003983A1
Application number: PCT/DE1981/000169
Authority: WO
Inventors: Hermann Ruf
Original assignee: Hermann Ruf
Priority date: 1981-05-18
Filing date: 1981-10-08
Publication date: 1982-11-25
Also published as: IT1192426B; IT8209406A0; DE8114666U1; IT8209406A1

Abstract

The additional surgical table usable for the extension and the reposition of a body extremity with a view to the preparation thereof for bone nailing, is characterized by a frame rolling on casters; the frame is comprised of a longitudinal support, having a proximal cross-bar and a distal cross-bar. The proximal cross-bar carries a counter-bearing; the distal cross-bar carries at each end a pivoting arm; each of those arms carries an orientable extension sleeve. In order to provide to the operators and to the video camera a free access to the operating field, the counter bearing (19) may be displaced vertically by means of a pipe fitted in the support (11) fixed to the proximal cross-bar. The distal cross-bar (14) is provided at each of its two ends with a fixed post (17, 18). Each of those two posts supports a pivoting arm (20, 30).

Description

Additional operating table for extension and reduction

description

The invention relates to a supplementary operating table for the extension and repositioning of an extremity as preparation for intramedullary nailing of bones or the like, with a frame which can be driven on rollers and which has a longitudinal beam with a proximal and a distal transverse beam, on which proximal crossbar an abutment and on the distal crossbar two swivel brackets with adjustable extension rods are attached.

Such an additional table was presented as a WITTMOSER table by B. Köhler and G. Scheuba at a symposium in February 1978 in Vienna and was described by V. Vecsei in "Locking Nailing", 1978, pages 21 to 2k. On a crosshead connecting two stamp heads are two vertically and laterally movable supports in the longitudinal direction of the additional table

Spare sheet displaceable, the working height can be varied by motorized drive of the stamp. The proximal punch carries two spaced vertically extendable supports which support the counter bearing. At the head of the distal punch, two extension arms are pivoted independently, on which extension stems are adjustably fastened.

Although this additional table is an indispensable aid for intramedullary nailing, it is still too bulky to operate. Thus, when the intramedullary nail is locked, the supports often have to be dismantled, since they impair the surgeon's field of work. Furthermore, the joints, particularly on the stamps of the additional table, are difficult to keep clean, so that hygienic problems often arise.

The invention is therefore based on the object of creating an additional table for the operating table for extension and repositioning which, while maintaining its full functionality, does not impede the operating field of the surgeon and free access to the fracture site for both _. allowed the surgeon as well as for the video image recording device.

For this purpose, the invention provides at the above-mentioned additional operating table that the counter bearing is mounted so that it can move vertically in a free-standing proximal support tube which is connected in one piece to the frame, and that a free-standing post is attached to the lateral ends of the distal frame crossbar on which one of the booms is mounted. By dispensing with a crossbar connecting the support tube with one or the other post, one results

^{Ersafeb, a «} U-shaped construction which allows unhindered access in the intermediate area between the support tube and the post, both for the surgeon and for the C-arms of the recording cameras. Since the connecting line from the support tube to each of the two posts is no longer parallel to the longitudinal beam, the additional table according to the invention can also be placed non-axially on the operating table, which is advantageous for many applications. Finally, the wide spacing of the posts from one another is advantageous for end nailing. Finally, the free space existing between the support tube and the post allows the coupling of a reduction device, such as the reduction mount according to the invention.

The repositioning bar has its own undercarriage, which passes underneath it for coupling to the side member. A central locking which is expediently provided according to the invention in the longitudinal beam and the crossbeam allows the additional table to be blocked or unlocked exactly by means of a single-lever operation without a reduction carriage or with the same.

The coupled reduction carriage carries on a narrow table two supports that can be moved in the longitudinal direction of the table, each of which can be independently adjusted laterally and in height. In addition, the table as a whole can be raised or lowered by one-hand operation, even with the supports already adjusted, which can be desirable for producing a valgus position or a varus position. According to the invention, this height adjustment takes place independently of

Ersε zb.at the other settings on the extension parts or on the counter bearing of the additional table according to the invention.

The aseptic of the additional table according to the invention does not pose any problems, since the functional parts of the table according to the invention are guaranteed without lubrication, readjustment or maintenance. The maintenance-free bearings, in particular the cantilever arm and the counter bearing, were encapsulated in such a way that dirt did not penetrate and the additional table could be easily cleaned.

The features of the additional table according to the invention are additionally defined in the appended claims.

The invention is described below with reference to the exemplary embodiment shown in the accompanying drawings. Show it:

1 is a perspective view of the additional table according to the invention for an operating table;

2 shows a schematic perspective illustration of the additional table to explain the different degrees of freedom of the counter-bearing and of the extension part on the additional table according to the invention;

FIG. 3 shows a perspective illustration of the additional table according to FIG. 1 with a coupled reduction carriage;

K shows a schematic perspective illustration of the repositioning mount according to the invention with supports and the height adjustability of the support table;

Ersafebϊait FIG. 5 shows a schematic view of a foot of the proximal crossbar; FIG.

Fig. 6 is a schematic view of a post on one of the lateral ends of the distal crossbar;

7-10 are a schematic view of the partially sectioned insert as well as the lower and upper locking disc and the boom head for the post according to FIG. 6;

11 shows a schematic illustration of the linkage for central locking;

12 and 13 a schematic view and top view of the bearing bush in the support tube 11;

Fig. 1 *. a schematic representation of the effect of the blocking block for the height adjustment of the counter bearing;

15 shows a schematic top view of the end plate of the support tube 11;

16 and 17 a schematic side view and top view of the head plate for the counter bearing guide shafts;

18 and 19 show a schematic side view and bottom view of the counter bearing head;

20 shows a schematic view of a vertical section through the support plate and its fastening;

FIG. 21 shows a schematic illustration of a view from below of the device from FIG. 20; and

Fig. 22 is a schematic representation of a ^'

Lifting cylinder for the reduction carriage.

Spare sheet 1. General structure

The extension additional table shown in FIGS. 1 to 3 in perspective view consists of a frame made of high-quality, lacquered or enamelled square steel tube which is double-T-shaped in plan view and U-shaped in side view. In particular, a longitudinal beam 12 is connected at both opposite ends to a proximal crossbeam 13 and distal crossbeams 14 and at the connection point to the proximal crossbeam 13 to an upright, free-standing support tube 11. A free-standing, upright post 17, 18 is attached to each of the two lateral ends of the distal crossbar 14, the two posts 17 and 18 each rising only up to approximately half the height of the support tube 11. The support tube 11 ends above the normal working height of an operating table 5. This basic shape of the frame leaves free space between the support tube 11 and each of the posts 17 and 18 and between the post, which gives the surgeon the greatest possible freedom of movement and also the Possibility offers, in a manner still to be explained, a fixed reduction mount in the space between the support tube 11 and the posts 17, 18 on the side member 12.

A right foot 15 and a left foot 16 are fastened to the two lateral ends of the proximal transverse beam 13, of which the foot 15 schematically shows FIG. 5. Each of the two feet 15, 16 and each of the

Replacement sheet Both posts -17 and 18 are drilled out from below, so that the sleeve of a commercial roller 1, 2, 3 is inserted and anchored from below into the base 15, the base 16 and the post 17 and the post 18 ^" can.

As FIGS. 1 to 3 also show, at the upper end of the post 17 there is a cantilever, generally designated 20, as the support of an extension stem, and at the upper end of the post 18, a similar cantilever, generally designated 30, for another extension stem. Each of the two brackets 20, 30 is pivotable about the axis of the associated post 17, 18 by 360 ° in the horizontal plane. On the extension arm 29, 39 a rider 62, 82 can also be locked, which carries a horizontal guide for an extension rod 64, 84. At the upper end of the extension rod 64, 84, a spindle gear 65, 85 which can be actuated by a handwheel is pivotably mounted about a horizontal and vertical axis, the pivoting range about the horizontal axis being approximately 20 in the exemplary embodiment shown. A spindle 66, 86 can be moved axially forward or backward from the spindle gear 65, 85 by turning the handwheel mentioned, and at the end opposite the handwheel, the spindle 66, 86 carries an extension plate 68, 88 in a combined joint, which enables a lockable pivoting of the extension plate 68, 88 both about the axis of the spindle 66, 86 and about a horizontal axis. With this conception of the adjustment possibilities, the extension plate 68, 88 can be placed in any desired position and in any desired position

Ersafebaft Alignment can be fixed in space without the free working space of the surgeon and his assistant between the support tube 11 and the distal post 17, 18 and between these posts being impaired by the joints of the extension stems. The joints and gears are maintenance-free and lubricant-free and can be subjected to high loads under pressure or tension and thus meet the special requirements in the operating room resulting from aseptics.

The guide tube 11 supports and guides two counter bearing guide shafts 116, 118, which are arranged one behind the other parallel to the longitudinal beam 12, carry a counter bearing head 190 as counter bearing 19 at the free, outer end and are adjustable in height. The guide and mounting of the counter-bearing guide shafts 116, 118 in the support tube 11, which will be described in detail, absorbs all mechanical loads that occur without the support tube 11 or the guide shafts 116, 118 made of high-quality stainless steel bending elastically. For example, a hook 199 or a support table 250 to be described can be inserted into lateral openings of the counter bearing head 190 and locked in a defined position. The slenderness of the guide tube 11 with the counter bearing 19 allows the image recording camera and the X-ray apparatus the greatest possible freedom of movement, so that the extension auxiliary table also takes up a minimum of space with full mechanical rigidity in use.

Finally, it should be particularly emphasized that the concept on which the extension table is based also allows it to be placed on the operating table 5 at an acute angle.

Replacement Biaff 2. Central locking

A further essential feature of the invention consists in a device in the form of a linkage which can be actuated by a lever 125 and which at the same time allows all the rollers 1, 2, 3, 4 to be blocked or released. For this purpose, according to FIG. 11, the already mentioned sleeve of the two proximal rollers 1, 2 is coupled to a rod 121 which extends freely in the interior of the proximal transverse beam 13. At the two opposite ends, the rod 121 is connected in a rotationally fixed manner to a lever which is mounted in the interior of the sleeves and which, in a manner known per se, completely blocks the associated impeller of the roller or releases it when rotating in the opposite direction. A transmission rod 120 is coupled in the middle to the rod 121 such that an axial displacement of the rod 120 results in the rod 121 rotating about its axis. At the end of the transmission rod 120 opposite the rod 121, the transmission rod 120 is the same In this way, it is coupled to a rod 122 which extends in the distal crossbar 14 and, like the rod 121, is connected in a rotationally fixed manner to the levers inside the sleeves of the rollers 3, 4. The connecting rod 120 is finally connected to a pin 126 pivotable lever 125 coupled out of an opening 124 of the distal crossbar 14, the pin 126 being rotatably mounted on the crossbar 14. In this way, the rod 121 and the rod 122 can be synchronized by pulling up or pushing down the handle 125 in the blocking direction or in a manner causing the loosening of the wheels of the rollers 1 ... 4. Since the linkage 120, 121, 122 perfect

Substitute Blaff '- ^O O ^M M ^H PI

/ *, "^" IPCT ^" - run inside the crossbeams 13, 14 and the longitudinal beam 12 without being stored in them, this is not only hidden from view but also reliably protected against dirt. This encapsulation of the central block is thus in line with the easy cleaning of the additional table according to the invention.

The aforementioned sleeve of a wheel is accommodated in a central bore 15.1 of the foot 15 from below and can be secured by mandrels screwed into threaded holes 15.2, .15.3. The square opening in the sleeve for inserting approximately the right end of the rod 121 is indicated in FIG.

To use the sleeves for the wheels 3, 4, the lower end of the post 17 and the lower end of the post 18 are drilled, as indicated in FIG. 6 by means of the post 17 at 17.1. The holes 17.3 and 17.2 allow the sleeve to be locked in the hole 17.1. The opening through which the right end of the rod 122 extends into the sleeve is indicated at ^" 17.4,

Since the foot 16 and the post 18 are designed in exactly the same way as the foot 15 described and the post 17 described so far, the description of those is omitted.

3. Boom storage

Another important feature of the invention is the complete encapsulation of the cantilever bearing, the essential parts of which in the axial alignment are shown in FIGS. 7-10

Replacement discount are recognizable. For this purpose, the post 17 is first fully drilled out by extending the bore 17.1 upwards and thus represents a hollow tube. The insert 22 is inserted into the upper opening of the post 17 and anchored by radial screws. The insert 22 consists of an elongated lower shaft 22.1, a radial section 22.2 widened to the outer diameter of the post 17 and a bearing journal 22.3 which adjoins this axially upwards. If the insert 22 is anchored in the post 17, the lower radially projecting shoulder 22.5 of the insert 22 rests on the upper end face 17.6 of the post 17.

The cantilever bearing 20 also includes a lower locking disk 24, the central through bore 24.1 of which surrounds the bearing journal 22.3 at a distance when the lower locking disk 24 is screwed onto the upper annular shoulder 22.6 of section 22.2 in an axial orientation. The radially enlarged bore surrounds the top

24.1 a ratchet ring gear 24.6 with upwardly projecting, radially extending ratchet teeth 24.2.

Another part of the boom bearing 20 is the upper locking disk 26, which has a central bearing sleeve 26.2 which is elongated in the axial direction. The Lich¬ te width of the bearing sleeve 26.2 is so little larger than the outer diameter of the bearing journal 22.3 that the bearing sleeve 26.2 rotates upon placement on the bearing journal 22.3, but without radial play. The outer diameter of the lower part of the bearing sleeve

26.2 is smaller than the clear width of the bore 24.1. The bearing sleeve 26.2 is surrounded by a radially projecting ring 26.3, the end face of which is ironed downward

Replacement discount is provided with a ring of locking teeth 26.4. The radially extending locking teeth 26.4 are intended to cooperate with the locking teeth 24.2 of the lower locking disc 24 when the upper locking disc 26 surrounds the bearing journal 22.3 such that the lower part of the bearing sleeve 26.2 rotates between the bearing journal 22.3 and the inner wall of the bore 24.1 the lower locking disc 24 screwed onto the insert 22 is arranged.

The cantilever bearing also includes a cantilever head 28 which, as a pot which is open at the bottom, is provided with a lateral, right-angled recess 28.4 in the casing for the cantilever arm 29. The clear width of the bore 28.1 forming the pot interior is only insignificantly larger than the largest outer diameter of the upper locking disk 26, the largest outer diameter of the lower locking disk 24 and the outer diameter of section 22.2 on the insert 22. The cantilever head 28 has in its bottom 28.2 also a central through hole 28.3 »

When the upper locking disk 26 is screwed into the bottom 28.2 of the boom head 28 in axial alignment with the bore 28.3 and the boom head 28 with the upper locking disk 26 is placed on the bearing journal 22.3, the outer wall 28.5 of the boom head 28 comprises both locking disks and an essential part of section 22.2. When the locking teeth 26.4 and 24.2 are in engagement, the part of the upper locking disk 26 which adjoins the bearing sleeve 26.2 radially outwards forms an annular chamber with the radially enlarged bore 24.1, into which annular spring assemblies (not shown) are introduced. These keep you relaxed

Erεafzbla t the locking teeth 26.4 and 24.2 out of engagement.

The boom bearing 20 is held together by an eccentric 27 (FIG. 1) provided with a hand lever, to which a threaded pin is articulated, which can be screwed through the bore 28.3 into the internal thread of a blind hole 22.7 in the bearing pin 22. 1, the lever of the eccentric 27 is pressed downward, the eccentric presses on the boom head 28, so that the upper locking disk 26 compresses the ring spring assembly in the chamber 26.3 so far that the locking teeth 26.4 and 24.2 come into engagement. In this way, by actuating the eccentric 27, the arm can be locked in defined angular positions determined by the distribution of the locking teeth 26.4 and 24.2.

From this graded adjustability of the arm 20, however, no problems arise in the practical use of the additional table, because if necessary, for example, the carriage 62 is pulled off the arm 29 and placed back on the arm 29 in a direction rotated by 180 ° to become. As a result of this, as well as through the other joints of the extension arm connected to the extension arm 29, a stepless adjustment of the extension plate 68 can be achieved in any case.

The outer bearing works maintenance-free and is secured against contamination by the cup-shaped design of the extension head 28, and can be cleaned very easily on the outside. 4. Counter bearing

Another important feature of the invention is the torsion-free mounting of the guide shafts 116, 118 and the design of the counter bearing 19.

For this purpose, a bearing bush 110 is anchored in the upper end of the support tube 11, which consists of solid brass and, according to FIGS. 12 and 13, is penetrated by two parallel longitudinal bores 112, 114. The length of the guide bush 110 is determined by the tilting moments which are exerted and taken up by the hook 199 in the counter bearing 19 and is several times greater than its width. The longitudinal bores 112, 114 are so finely worked out that the guide shafts 116, 118 for the counter bearing 19 are guided radially free of play in the longitudinal bores 112, 114 and yet are easy to move axially. The one of the two guide shafts 116, 118 made of high-quality stainless steel has at its lower end a stop, not shown, which limits the maximum height extension and cooperates with the underside 111 of the bearing bush 110, and the other of the two guide shafts 116, 118 has one the maximum insertion of the guide shafts limiting extension, which cooperates with a stop inside the support tube 11, the latter stop being arranged in the support tube 11 so that when the guide shafts 116, 118 are retracted fingers between the ^' counter bearing head 190 and the upper end of the guide tube 11 can not be clamped.

The bearing bush 110 has a radial recess 117, in which a wedge body 119 by means of a

OMPI

Replacement blaff Knurled screw 115, which can be operated from the outside, for locking the height of the guide shafts 116, 118 in the manner shown in FIG. 14 can be clamped against them.

The Führungsr.ohr 11 is closed with an inserted bearing bushing 110 by a plate 120 (Figure 15), which bores 121, ^"122 surrounding the guide shafts, and each one of these holes annular groove 123, has auf¬ 124th In each of the two annular grooves 123, A ring seal with an annular wiper lip bearing against the respective guide shaft 116, 118 is used 124. This reliably prevents dirt from penetrating into the bearing bush 110. As can be seen from FIGS. 13, 14 and 15, the guide shafts are 116, 118 are mounted one behind the other in the bearing bushing 110, which points parallel to the longitudinal direction of the longitudinal beam 12. Alternatively, the guide shafts 116, 118 could also be mounted next to one another transversely thereto, if the larger width of the support tube 11 can be tolerated .

The guide shafts 116, 118 are connected at their upper ends to a head plate 192 (FIGS. 16, 17) and steel pins driven by means of two through holes 193, 194 and 195, 196 of the head plate 192 are anchored in blind holes 197, 198 of the head plate 192. As shown in FIG. 17 in particular, the head plate 192 has a hole in each of its four corner regions, through which bolts can extend upwards for screwing on the counter bearing head 190. Furthermore, several pin holes are provided, into which locking pins can be inserted, the free ends of which extend in the counter bearing head 190 for additional adjustment and stabilization.

Ersafzbϊaff The counter bearing head 190 has the shape of a table with table top 185 and four corner legs 181, 182, 183, 184. The counter bearing head 190 stands with its legs on the surface 186 of the head plate 192 and is bolted and pinned to it in the manner mentioned. The head 190 milled out of a solid block has an intermediate space of defined width between the corner legs 181, 183 and 182, 184, which together with the surface 186 of the head plate 192 has an insertion channel

186 for an arm of the counter-bearing hook 199, for example. A pin is used to define a defined insertion depth, which extends from a bore 170 in the lower surface of the table top 185 between the legs 182, 184 into an aligned bore 172.

Another transverse insertion channel is laterally delimited by the legs 181, 182 and 183, 184, so that the hook 199 is inserted into the counter bearing head 190 in three different directions at right angles to one another and there by means of a knurled screw extending through a central bore 173 can be determined. It is understood that the hook 199 ends in a square rod, the dimensions of which extend into the insertion channel 186 and the transverse insertion channel

187 is matched.

5. Support plate

Another important feature of the invention is in the support plate 250 which can be attached to the counter bearing head 190 in accordance with FIG. Figures 20 and 21 embodied. The support plate 250

Ersafzbraff consists of natural polypropylene and is fully radiolucent. It has a sufficient width to support the patient's vessel and is rounded on a narrow side 251, but tapered. In this hand area, the support plate has a bore 252. Provided on the underside below area 251, which has an outer contour which is the same as the delimitation of area 251 and merges at the inner edge in a web 256 which previously extended to plate 250. The web 256, as shown in FIG. 21, is bent in the opposite direction to the contour of the region 251 and acts as a reinforcement for the region of the bore 252. Overall, this results in a fork consisting of the section 251, the web 256 and the plate piece 254. which is stiffened backwards by another web 258. The parts mentioned so far are integrally formed on the support plate 250 and, like this, consist of polypropylene. In alignment with the bore 252, an internally threaded bore 253 is cut in the plate piece 254.

A counter bearing post 240 has in its lower part shown in FIG. 20 an outwardly extending conical extension 242 which extends radially inwards at the lower end at 248 up to a slim pin 244. The pin 244 is provided with an external thread at least at the lower end, so that the counter bearing rod 240 can be screwed into the threaded bore 253 until the annular shoulder 248 is seated on the surface of the support plate section 251 (FIG. 20). In the area of the conical extension 242 and in the interior of the pin 244, a steel rod 246 is embedded in the counter bearing rod 240, which is otherwise made of polypropylene.

..rsafeb.a « The clear width of the fork is dimensioned such that it can receive the end of a steel square bar 260, the distal end of which, not shown in FIG. 20, can be inserted into the counter-bearing head 190. The rod 260 has a bore 262 through which the pin 244 extends. It can be seen that the support plate 250 can be pivoted laterally about the pin 244 in the bore 262 of the bar 260 around the axis of the counter bearing bar 240. Since the counter bearing rod 240 and the support plate 250 are X-ray transparent, they do not hinder the creation of X-ray images in the thigh-neck area. Furthermore, the support plate 250 can be pivoted to the side, for example when plaster pants are to be put on the patient.

6. Reduction carriage coupling device

Another important feature of the invention resides in the coupling device of the reduction carriage, which enables the extension table described so far to be expanded to a reduction extension table. 3 and 4 in particular, the reduction mount according to the invention consists of a running gear which, in plan view, consists of an H-welded frame with cross members 52 and 56 and a mount longitudinal member 54 connecting them in the center. A punch, generally designated 520, is anchored free-standing in the center on the cross member 52, and a punch 540 of the same type is anchored in the center on the cross member 56. The punches 520 and 540 are connected at their upper ends to a table 510 which extends parallel to the carriage longitudinal member 54 and on which two

Er-S ^^ T-stf Supports 600 and 800 can be moved transversely and locked. Each of the supports 600, 800 carries a fixation ring 650 and 850. Each of the two fixation rings 650, 850 is attached to the associated support 600 or 800 in the manner shown in FIG.

An essential feature of the reduction mount, which is denoted overall by 50, is the height adjustability of the table 10 by means of a handwheel 530 which is provided on a narrow side of the table 510 and, in a descriptive manner, two in each case in the stamps 520 and 540 arranged spindle drives adjusted synchronously.

The rigid coupling of the reduction carriage 50 to the additional table succeeds with two measures: The overall height of the _r carriage of the reduction carriage 50 is lower than the distance of the lower edge of the longitudinal member 12 from the running plane of the wheels of the rollers 1, 2, 3, 4. This can The carriage of the reduction carriage 50 is moved to just before the punches 520, 540 under the cross member 12.

The second measure is the coupling device on the longitudinal member 54 which has an adjusting lever 53 on one side of the longitudinal member 54 and a coupling element 58 on the opposite side of the longitudinal member. The lever 53 and the coupling element 58 are non-rotatably seated on a common rotatable shaft, not shown, mounted in a lateral extension of the lamella longitudinal member 54.

_ OMPI

A IPO ^"" replacement blaff ^ taiio ^ The coupling element 8 consists of a circular disk-shaped plastic plate 58.1 flattened on one side, the thickness of which increases continuously in the axial direction. The plastic disc can be reinforced by a deposited metal disc. The coupling device of the repositioning carriage 0 also includes two post-like cams 55, 57, which rise from the carriage longitudinal member 54. The distance to the clutch disc 58.1 taken transversely to the connecting line of the cams 55, 57 is dimensioned such that the width of the side member 12 between the cams 55 and 57 on the one hand and the clutch disc 58.I can be captured.

Therefore, if the lever 53 is flipped over, the flattened side of the clutch disc 58.1 points upward, and the reduction mount 50 is pushed so far under the longitudinal member 50 that its side surface facing the mount 50 bears against the cams 55, 57, the lever 53 can be moved so that the wedge surface of the clutch disc 58.1 engages behind the side surface of the side member 12 facing away from the cams 55, 57 and in this way anchors the carriage 50 to the additional table. For this purpose, the shaft connecting the lever 53 and the clutch disc 58.1 is axially tight and resiliently mounted, so that the coupling mount 50 sits tightly on the side member 12. In this way, the reduction mount 50 is an additional device rigidly connected to the additional table, which, thanks to the rollers under the cross beams 52, 56, can be moved as desired together with the additional table and can be blocked with it.

This makes it possible in cases where a repositioning of a fracture is not necessary

Ersazbla « to free the nesting table from the reduction device that is then not required. If necessary, however, the additional table can be additionally equipped with the rigidly coupled repositioning device 50.

7. Height adjustment of the reduction table

A device is accommodated in each stamp 520, 540, which is shown schematically in FIG. 22 and is described in connection with the stamp 520. A tube piece 532 is anchored on the cross member 5 and a nut 526 is firmly screwed into its upper opening. A punch head 534 screwed to the table 510 has a wide axial bore in the lower part, into which a casing tube 522 is inserted. The clear width of the casing tube 522 is slightly larger than the largest outer diameter of the tube piece 32 and the nut 526. In the head 534 is axially immovable but a spindle mounted rotatably 524 ^'. The type of storage is not shown in detail in FIG. 22, but can easily be implemented on the basis of what is shown. The head 534 has a bore 536 from above, which tapers downward toward a depression 538. In the depression 538 there is a bevel gear connected to the upper end 537 of the spindle, which rotates with the spindle in a horizontal plane. The bevel gear, not shown, connected to the spindle meshes with a further bevel gear, which sits non-rotatably on a continuous shaft, which is carried out through a lateral bore 535 in the upper part above the end of the spindle 524. On the

Replacement juice The setting wheel 530 can be attached to the end of this shaft which is led out laterally from the table 510.

If the adjusting wheel 530 is rotated, the shaft extending through the opening 535 and the bevel gear seated thereon, which rotates the bevel gear connected to the spindle 524, rotate with it. The spindle rotating in the fixed nut 526 rises or falls accordingly. Since the same drive device is accommodated in the punch 540, the spindle drives arranged in the two punches 520, 540 are moved synchronously by rotating the handwheel 530, so that the table 510 rises or falls in parallel.

This version of the spindle drive is not only maintenance-free, but is also fully secured against contamination by the elongated tube 522 or 542. The punches 520, 540 of the reduction mount can therefore be cleaned extremely easily and completely.

The invention is shown in the accompanying brochures on an extension table and on an additional table for extension and repositioning, both in the supporting features shown in FIGS. 1 to 4 and in further photographic representations, both of which show details of the ^"Vorrich¬ inventive processing as well as its advantages connexion when used in Zu¬ with the nailing show. text and figures of these two brochures as well as the attached claims are An¬ additional disclosures of the invention.

Replacement blade Despite the. However, the particular embodiment of the invention shown is immediately obvious to the person skilled in the art that the invention is not restricted to details of the device shown.

The casing tube 522 encompasses (in contrast to the schematic representation in FIG. 22) the outer periphery of the tube piece 532 closely without any substantial radial play, but can be displaced longitudinally. At the lower end of the casing pipe 522, a bushing consisting of three half-shells is inserted into a recess in the inner surface of the casing pipe, which enables the pipe section 532 to be sealed and further guided by the casing pipe 522 on the outer periphery of the pipe section 532. In this way, the spindle gear is also encapsulated against dirt from the outside.

Replacement baffle

Claims

' Expectations

1. Additional operating table for the extension of an extremity as preparation for intramedullary bone or the like, with a frame that can be driven on rollers and has a longitudinal beam with a proximal and a distal crossbar and on its proximal side a counter bearing and on its distal side two pivotable brackets are fastened with adjustable extension rods, characterized in that the counter bearing (19) is vertically movably mounted in a free-standing, proximal support tube (11) which is integral with the frame (12, 13, 14), and at the lateral ends of the distal frame crossbar (14), a free-standing post (17, 18) is attached, on which one of the brackets (20, 30) is mounted.

2. Additional table according to claim 1, characterized in that the longitudinal beam (12) and the crossbeams (13, 14) are hollow profiles in which there is a linkage (120, 121, 122) of an externally (at 125) central locking operable for the roles (1, 2, 3, 4) extends.

3. Additional table according to claim 1 or 2, characterized gekenn¬ characterized in that each roll (1 ... 4) has a sleeve which are held in one of the feet (15, 16) and posts (17, 18) , wherein in the sleeve a stamp for blocking the impeller is movable and the linkage (120, 121, 122) for central locking is mounted on the sleeves of the rollers.

Spare sheet

4. Additional table according to one of the preceding claims, characterized in that the distal crossbar (14) has a rear opening (124) from which a

^' operating lever ^' (125) connected to the linkage (120, 121, 122) for central locking.

5. Additional table according to one of the preceding claims, characterized in that the lower edges of the longitudinal beam (12) and the crossbar (13, 14) have a distance from the running plane of the wheels der¬ art that the longitudinal beam and the crossbar from the chassis ( 52, 54, 56) of a reduction table (50) can be driven under.

6. Additional table according to one of the preceding claims, characterized in that in the support tube (11) a bearing bush (110) whose length is substantially greater than its width is anchored, which two parallel through holes (112, 114) for counter-bearing guide shafts (116, 118).

7. Additional table according to one of the preceding claims, characterized in that the bearing bush (110)

• has a lateral opening (117) for a wedge body (119) for locking the height of the counter-bearing guide shafts (116, 118).

8. Additional table according to one of the preceding claims, characterized in that a counter bearing head (190, 192) is mounted on the counter bearing guide shafts (116, 118), which has at least one lateral

Replacement juice Has opening (194, 196) for lockable insertion of a counter-bearing hook (199) or the like (250, Fig. 20 and 21).

9, additional table according to one of the preceding claims, characterized in that the counter-bearing head has two insertion channels (194, 196) which are laterally offset by 90 ° and have a right-angled cross section.

10. Additional table according to one of the preceding claims, characterized in that an X-ray transparent support plate (250) is inserted into one of the openings (194, 196) of the counter bearing head.

11. Additional table according to one of the preceding claims, characterized in that the support plate (250) is mounted on an arm (260) which can be inserted into the opening (194, 196) so as to be pivotable about a vertical axis.

12. Additional table according to one of the preceding claims, characterized in that the support plate consists of natural polypropylene.

13. Additional table according to one of the preceding claims, characterized in that the support plate (250) about a shaft (256) in the arm (260) is rotatably mounted, which is provided at least in the swivel range with a steel core and otherwise made of X-ray transparent plastic consists.

Spare bill

14. Additional table according to one of the preceding claims, characterized in that each of the arms (20, 30) consists of an arm (29, 39) with a rectangular profile and a boom head (28, 38) which on the post (17, 18th ) is pivoted through 360 °.

15. Additional table according to one of the preceding claims, characterized in that the cantilever head (28, 38) has a jacket (28.5) which encapsulates the cantilever bearing and extends over the upper end of the post (17, 18).

16. Additional table according to one of the preceding claims, characterized in that within the casing (28.5) two locking disks (24, 26) are arranged vertically aligned one above the other and mesh with radial locking teeth (24.2, 26.4).

17. Additional table according to one of the preceding claims, characterized in that the upper locking disc (26) fixedly connected to the boom head (28, 38) has an axial bearing bush (26.2) which has an upright shaft (22.3) one in the around the upper end of the post (17, 18) insert (22) radially without play.

18. Additional table according to one of the preceding claims, characterized in that an annular chamber (24.3) between the upper locking disc (26) and the lower locking disc (24) connected to the insert (22) radially within the Ras toothed ring (24.2, 26.4). is formed, in which several axially

OMPI

Ersat-blaft ^ Zw leaf spring rings acting in the direction are accommodated,

19. Additional table according to one of the preceding claims, characterized in that in the bearing shaft (22.3) of the insert (22) an upwardly open threaded blind hole (22.7) is formed, in which the threaded pin one from the cantilever Bearing head (28, 38) is anchored to the axially projecting eccentric lever (27, 37) which axially acts on the boom head (28, 38) against the action of the leaf spring rings.

20. Additional table according to one of the preceding claims, characterized in that on each cantilever arm (29, 39) sits a movable clamping tab (62, 82) which has a vertical guide for a height-adjustable extension rod (64, 84).

21. Additional table according to one of the preceding claims, characterized in that at the upper end of the extension rod, a spindle (66, 86) is axially displaceable as an extension shaft and is pivotably mounted about a horizontal axis.

22. Additional table according to one of the preceding claims, characterized in that the proximal end of the spindle (66, 86) carries an extension plate (68, 88) which is pivotally mounted on the spindle end about two horizontal axes.

23. Additional table according to one of the preceding claims, characterized in that between the support tube (11) and post (17, 18) a reduction mount (50) is releasably attached to the side member (12).

Ersafzbϊatf

24. Additional table according to one of the preceding claims, characterized in that the chassis (52, 54, 56) of the reduction mount (50) consists of a longitudinal side member (54) and two cross members (52, 56) and has a lower overall height, than the lower edge of the side member (12).

25. Additional table according to one of the preceding claims, characterized in that in the carriage longitudinal member (54) to the cross members (52 56) paral¬ lele shaft is axially elastically mounted, which has an operating lever (53) and at one end opposite end carries a coupling element (58).

26. Additional table according to one of the preceding claims, characterized in that the coupling element is a reinforced plastic disk (58.1), the axial thickness of which increases in the circumferential direction, with at least one stop (55, 57) being provided on the longitudinal member (54) that the side member (12) can be clamped between the disc (58.I) and stop.

27. Additional table according to one of the preceding claims, characterized in that the stop consists of two plastic-coated cams (55, 57).

28. Additional table according to one of the preceding claims, characterized in that the reduction carriage (50) has a height-adjustable table (510) on which two support brackets (600, 800) parallel to the longitudinal carriage (54) are movable and lockable.

Replacement blade

29 «Additional table, according to one of the preceding claims, characterized 'in that the table is fastened on two stamps (520, 540) which can be extended and are fastened standing at the ends of the carriage longitudinal member (54).

30, additional table according to one of the preceding claims, characterized in that each punch (520, 540) consists of an elongated sleeve (522, 542) fastened to the table (510) which has an axial, from the outside (at 530) operable spindle gear (524, 526) encloses.

31. Additional table according to one of the preceding claims, characterized in that the two Spindelge¬ gears in each punch (520, 540) by a common actuating shaft which is rotatable by a handwheel (530) mounted on the outside of the side of the table (510) , are adjustable together.

Spare sheet