WO2003082161A1

WO2003082161A1 - Fracture brace

Info

Publication number: WO2003082161A1
Application number: PCT/GB2003/001397
Authority: WO
Inventors: Douglas Wardlaw
Original assignee: Grampian University Hospitals Nhs Trust
Priority date: 2002-03-28
Filing date: 2003-03-28
Publication date: 2003-10-09
Also published as: GB0207399D0; AU2003224245A1

Abstract

A brace for treatment of a fracture is described, for example a fracture in a human limb. Typical embodiments include first and second load applicators and means for holding the first and second load applicator in relative position when fitted about a fracture.

Description

Fracture Brace

This invention relates to a brace for treatment of a fracture, in particular a brace for treatment of a fracture to a human limb, for example a fracture to the lower end of the radius.

The most common fracture treatment uses a plaster of Paris cast, which is applied at the time of fracture reduction. The cast effectively immobilises the fractured area, but can thus result in the fractured area being very stiff after the fracture has healed and the cast removed. Also, this method of treatment is not always successful in maintaining the fracture position and may leave significant long-term deformity of the fractured area.

Fracture braces are known which attempt to overcome the disadvantages of casts. For example, a fracture brace is disclosed in GB 2193102 and EP 0255388. The brace is rigid and comprises two main portions, conjoined together by two elasticated Velcro straps. A first portion covers the dorso-radial surface of the forearm from the level of the radio-carpal joint and radial syloid for approximately two thirds of the forearm. At either end of the brace, there are two specified areas of high loading. A second portion is applied to the antero-ulnar aspect of the forearm and has a similar raised area of a specified size. This fracture brace allows earlier mobilisation of the fracture area than a cast but fails to maintain the fracture position adequately enough to allow a significant long term advantage.

A further alternative form of treatment is to use external fixators whereby pins are applied to the fracture. The fracture is reduced and the external fixator is applied holding the fracture fragments in a distracted, reduced position. Unfortunately, this immobilises the wrist and leaves a very stiff wrist which again requires a long period of rehabilitation. External fixation has also been applied to the less comminuted fractures where there is one fairly large distal fragment through which pins can be inserted and this is done along with pins in the radius proximal to the fracture. The external fixator is then able to hold the fracture reduced and allow the wrist to move. However, the external fixator in this position is cumbersome, resulting in patients having difficulty performing normal day to day activities, such as dressing. Pint tract infection may occur in some cases. According to the present invention there is provided a brace for treatment of a fracture, having at least one loading area adapted for placement of a first fixating means therethrough into a first bone portion on one side of a fracture, and placement of a second fixating means therethrough into a second bone portion on the other side of the fracture.

Typically the brace comprises first and second load applicators, and optionally means for holding the first and second load applicators in relative position when fitted about a fracture. The first load applicator can comprise the at least one loading area, and typically comprises a distal loading area and a proximal loading area, wherein the distal loading area is adapted for placement of the fixating means therethrough into the fracture.

Typically the first and second bone portions are respective fragments of bone, but the brace of the invention is not restricted to fractures that have comminuted bone fragments, and green stick or other fractures can usefully be treated by this brace. Preferably the first bone portion is distal relative to the second proximal bone portion.

Embodiments of the present invention can thus provide enhanced fracture reduction and corrective alignment, and improved stability of fracture bones and/or mobility of joints. Hence, use of the brace can provide a decreased incidence of deformity and/or morbidity as bones and joints are allowed free movement in a stabilised manner.

The invention also provides a method of treating a fracture, comprising the steps of applying a brace to the fracture, the brace having at least one loading area adapted for receiving bone fixating means therethrough; passing a first fixating means through the loading area of the brace into a first bone portion on one side of a fracture; and passing a second fixating means through the loading area of the brace into a second bone portion on the other side of the fracture.

The use of first and second fixating means, for example, through the distal loading area into a distal fragment of a fracture and a proximal bone fragment adjacent the fracture respectively, provides advantages over conventional fracture braces. The use of said second fixating means gives the brace improved attachment to the undamaged bone adjacent the fracture, and helps prevent shortening of the fracture during healing. The second fixating mans helps protect the fracture from undue external forces. The distal loading area is preferably of such a size as to provide loading to the whole area of the distal fracture fragment, and to provide similar loading to e.g. an intact portion of bone adjacent to the fracture, i.e. the second portion. This loading on the intact portion of the bone adjacent the fracture acts as a stop to help prevent over-reduction of the fracture. The second load applicator, and the distal and proximal loading areas of the first load applicator, may be of conventional structure for use in a fracture brace, as is known in the art. For example, the first and second load applicators may be fixed in relation to each other, for example moulded as an integral piece, or may be fixed relative to one another by one or more rigid fixing members. The load applicators will typically be made of preformed moulded plastics material.

The means for holding the first and second load applicators in relative position around a fracture may be any suitable means. For example, said means for holding may comprise an adjustable or resilient strap, for example an elasticated Velcro™ strap.

The fracture brace of the present invention preferably further comprises a resilient member which conjoins the distal and proximal loading areas. The resilient member is preferably elastically deformable when fitted about a fracture. In this way, as swelling at the fracture location decreases, the resilient member can store energy when it is deformed, which energy is released as it returns to its initial shape. In this way pressure can be maintained substantially constant on the fracture area during treatment.

The resilient member should be flexible, so that it can deform when the brace is fitted around a fracture, returning to its original shape as the fracture swelling reduces. The resilient member preferably consists substantially of a resilient material, conveniently plastics materials, for example polypropylene. The resilient member preferably comprises one or more elongate members attached at each end to the distal and proximal loading areas respectively. The use of such a resilient member enables the loading to be maintained more uniformly as the fracture swelling is reduced.

Alternatively, the proximal and distal loading areas of the first load applicator may be part of an integral structure, for example without such a resilient member, using straps to maintain loading.

The first and second fixating means used in the present invention may comprise, for example, metal pins or Kirschner wires (K-wires) to be inserted through the distal loading area into the distal fracture fragment and adjacent proximal bone fragment. The first and/or second fixating means may be screwed or otherwise fixed to the bone to prevent movement of the fixating means either further into or out of the bone, and may be screwed or otherwise fixed to the distal loading area to prevent relative movement of the fixating means therewith. In addition to the first and second fixating means in the distal fracture fragment and adjacent proximal bone fragment, the proximal loading area may be adapted for placement of fixating means therethrough into a proximal bone fragment .

The brace is typically adapted for use with a limb fracture .

An embodiment of the present invention will now be described in detail by way of example, with reference to the accompanying drawings, in which:

Figure 1 shows first and second load applicators for use in a brace of the present invention; Figure 2 shows a brace of the present invention in position fitted around a fractured wrist from the dorso-radial side; Figure 3 shows the brace of Figure 2 from the antero-ulnar side; and Figure 4 shows first and second fixating means inserted into a distal fracture fragment and proximal bone fragment respectively.

Referring to Figure 1, a brace 1 comprises a first load applicator 3 and second load applicator 2. In this embodiment, the second applicator 2 is an antero-ulnar portion, and the first applicator 3 is a dorso-radial portion. The means for holding the first 3 and second 2 load applicators in relative position when fitted about a fracture comprises an elasticated Velcro™ strap 4, to which the second load applicator 2 is attached. The first applicator 3 has a proximal loading area 5, and a distal loading area 6. The proximal 5 and distal 6 loading areas are conjoined by two resilient polypropylene struts 7. The distal loading area 6 comprises a first 8 and second 10 set of holes therein, through which first and second fixating means, namely K- wires, (not shown in Figure 1) can pass.

Referring to Figures 2 and 3, in use the brace 1 is applied as shown. The first load applicator 3 covers the dorso-radial surface of the forearm from the level of the radio-carpal joint and radial syloid proximally for approximately two thirds of the forearm. The second load applicator 2 of the brace 1 is applied to the antero-ulnar aspect of the forearm, and is fixed in position around the fracture relative to the first load applicator 3 by strap 4. A first set of distal K-wires 12 pass through the distal loading area 6 into the distal fracture fragment, and a second set of proximal K- wires 14 pass through the distal loading area 6 into the proximal bone fragment. The positioning of the first 12 and second 14 sets of K-wires is shown in more detail in Figure 4.

To apply the brace 1, the fracture is reduced, and the K-wires 12, 14 are inserted into the distal fracture fragment and proximal bone fragment as is conventional in the art, for example using a jig. The jig spaces the wires 12, 14 and directs them such that they enter the bone appropriately. The distal loading area 6 has first 8 and second 10 sets of holes therein corresponding to the spacing of the wires 12, 14 in the jig, and is fitted over the wires 12, 14. The wires 12, 14 are then fixed to the distal loading area 6 by conventional means, for example a crimping mechanism, to ensure that no migration of the wires 12, 14 occurs. The first 3 and second 2 load applicators are then positioned, and the strap 4 tightened and tensioned. When the brace 1 is tensioned the resilient struts of polypropylene 7 will tend to straighten out. Energy is thus stored in the deformed polypropylene struts 7 which act as a spring.

Modifications and improvements can be incorporated without departing from the scope of the invention.

Claims

1. A brace for treatment of a fracture, having at least one loading area adapted for placement of a first fixating means therethrough into a first bone portion on one side of a fracture, and placement of a second fixating means therethrough into a second bone portion on the other side of the fracture.

2. A brace as claimed in claim 1, wherein the first bone portion is a distal bone portion, and the second bone portion is a proximal bone portion.

3. A brace as claimed in claim 1 or claim 2, wherein the brace comprises first and second components, the at least one loading area forming a part of one of the components.

4. A brace as claimed in claim 3, wherein the at least one loading area forms a part of the first component, the first component also having an additional loading area proximal to the at least one loading area.

5. A brace as claimed in claim 4, wherein the two loading areas of the first component are conjoined by a resilient member which is elastically deformable when fitted about a fracture.

6. A brace as claimed in claim 5, wherein the resilient member comprises one or more elongate members.

7. A brace as claimed in claim 5 or claim 6, wherein the resilient member comprises polypropylene.

8. A brace as claimed in any of claims 4 to 7, wherein the proximal loading area of the first component is adapted for placement of fixating means therethrough into a proximal bone fragment .

9. A brace as claimed in any of claims 3 to 8, wherein the second component comprises at least one further loading area.

10. A brace as claimed in any of claims 3 to 9, wherein the brace also includes means for holding the first and second components in relative position when fitted about a fracture.

11. A brace as claimed in any preceding claim, wherein the first and/or second fixating means comprises K-wires and/or pins.

12. A brace as claimed in any preceding claim, adapted to treat bone fractures of the human body.

13. A brace as claimed in claim 12, adapted for use on a human limb.

14. A brace as claimed in any preceding claim, wherein the at least one loading area is of such a size as to exert loading on the whole area of the fracture as well as an area of an intact portion of the bone .

15. A method of treating a fracture, comprising the steps of applying a brace to the fracture, the brace having at least one loading area adapted for receiving bone fixating means therethrough; passing a first fixating means through the loading area of the brace into a first bone portion on one side of a fracture; and passing a second fixating means through the loading area of the brace into a second bone portion on the other side of the fracture.

16. A brace substantially as hereinbefore described with reference to the accompanying drawings.