OPERATIONAL PUFFS FOR HOLDING TWO BONE PIECES

Description

[0001] The present invention relates to a surgical forceps according to the preamble of claim 1.

[0002] Such a surgical forceps, also called repositioning forceps or repositioning forceps, is known from publication CN 102 166 132 A or from US 1 985 108 A.

[0003] WO2020153615A1 discloses a forceps for internal fixation comprising: a first element with a first gripping part for grasping a first lateral surface of a bone and a first handle extending from the first gripping part; and a second element with a second gripping part for grasping a second lateral surface of the bone spaced at a predetermined distance from the first lateral surface of the bone, and a second handle extending from the second gripping part.

[0004] US2018168707A1 describes a clamping device for bone reduction and internal fixation with a scissor-like structure containing two clamping elements pivotally connected to each other and featuring arc-shaped elements to hold bone and fixation plates during surgery. This device is specifically used for the treatment of comminuted fractures by firmly holding the bone and providing traction to align the fracture without the need to remove the device during surgery.

[0005] The purpose of the invention is to improve the known surgical forceps.

[0006] The problem is solved by the characteristics of independent claims.

[0007] Preferred training opportunities are subject to dependent claims.

[0008] According to one aspect of the invention, a surgical forceps for holding two bone fragments of a fractured bone at a fracture site comprises a first forceps part extending in a radial direction and a second forceps part extending in the radial direction, which is rotatably held about a pivot point by a lock on the first forceps part, wherein each forceps part has a forceps head with a clamping section at one end in the radial direction, such that the bone fragments can be clamped between the forceps heads at the clamping sections. According to the invention, each forceps part has a shoulder extending transversely to the radial direction and transversely to the direction of rotation between the clamping sections and the lock, to which a plate for osteosynthesis of the bone fragments can be attached opposite to the radial direction.

[0009] The invention is based on the consideration that conventional bone repositioning requires several tools and / or hands. In addition to potentially pre-drilling the bone and placing a Kirschner wire, the bone fragments must be correctly positioned, and the osteosynthesis material must be correctly placed. Traditionally, different surgical forceps are used for these two tasks. While the aforementioned surgical forceps can clamp and fix correctly positioned bone fragments simultaneously with the osteosynthesis material, several hands and / or tools are still required for the correct positioning of the bone fragments and the simultaneous correct arrangement of the osteosynthesis material—that is, up to the actual clamping process.

[0010] The specified surgical forceps are designed to clamp the bone fragments sequentially, rather than simultaneously with the osteosynthesis material. The shoulder of the forceps is used for this purpose, securing the osteosynthesis material in a different direction than the clamping direction of the forceps' jaws. This allows a single tool to first correctly fix the position of the bone fragments and then, simultaneously with the application of the forceps, to determine the position of the osteosynthesis material. Therefore, using these forceps reduces the number of surgical instruments required.

[0011] In a further training course, the specified surgical forceps include a spacer in each clamping section, positioned radially in front of the shoulder. This spacer is designed to maintain a predetermined minimum distance between the bone fragments and the shoulder. While this minimum distance allows for adjustment of the osteosynthesis material's position relative to the fixed bone fragments, it also allows for a certain degree of mechanical play. This enables the relative position of the osteosynthesis material on the fixed bone fragments to be adjusted as needed before screwing.

[0012] In a preferred embodiment of the described surgical forceps, the spacer is formed by the clamping sections converging in the radial direction in front of the shoulders. In this way, the spacer can be formed integrally with the clamping sections and thus integrated cost-effectively into the surgical forceps.

[0013] According to the invention, the shoulders are designed as opposing projections between the clamping sections and the lock. These projections can be attached either integrally with the surgical forceps or as separate elements to an existing surgical forceps, so that the concept behind the described surgical forceps can, in principle, also be implemented on conventional surgical forceps through modification.

[0014] According to the invention, at least two projections are arranged next to each other to form the shoulders of the forceps parts. In this way, the individual projections can be made smaller and thus more easily incorporated into the surgical forceps, for example, during the initial forming process.

[0015] In a further development of the specified surgical forceps, each forceps head has a recess in the area of ​​its clamping section extending against the radial direction, which separates the clamping section into a first fork tine and a second fork tine, and wherein the fork tines of one clamping area are thinner when viewed transversely to the radial direction and transversely to the direction of rotation than the fork tines of the other clamping area.

[0016] In a further development of the specified surgical forceps, the thinner fork tines are arranged on one side opposite the insertion side of a fixation screw for osteosynthesis of the bone fragments. This allows a screw to be easily inserted obliquely through the recess and thus through the bone to be repositioned.

[0017] In a further development of the aforementioned surgical forceps, the fork tines are designed to be elastic in the direction of rotation, with a modulus of elasticity between 30 GPa and 100 GPa. Within this elasticity range, the fork tines can easily compensate for unevenness in the bone while still applying sufficient pressure to securely hold the bone fragments.

[0018] In a further development of the specified surgical forceps, the fork tines taper to a point in the radial direction. This allows for better tissue protection when using the specified surgical forceps.

[0019] In a further development of the specified surgical forceps, the contact areas differ in their surface roughness, which allows the specified surgical forceps to be positioned well with one of the two clamping sections, while the other of the two clamping sections provides positional stability when clamping.

[0020] The properties, features, and advantages of this invention described above, as well as the manner in which they are achieved, will become clearer in connection with the following description of the exemplary embodiments, which are explained in more detail in conjunction with the drawings. The drawings show: Fig. 1 a schematic view of a surgical forceps in the form of a repositioning forceps, Fig. 2 the repositioning pliers Fig. 1 in an application state, Fig. 3 a schematic view of clamping sections of the repositioning pliers Fig. 1 , Fig. 4 a bone with an oblique rotational fracture Fig. 5 the repositioning pliers Fig. 1 on the bone Fig. 4 from a first perspective, Fig. 6 the repositioning pliers Fig. 1 on the bone Fig. 4 from a second perspective, Fig. 7 a bone with a transverse fracture, and Fig. 8 the repositioning pliers Fig. 1 on the bone Fig. 7 .

[0021] The figures use identical technical elements with the same reference symbols and describe them only once. The figures are purely schematic and, above all, do not represent the actual geometric relationships.

[0022] It will be on Fig. 1 Reference is made to the figure which shows a schematic view of an operating forceps, hereinafter referred to as repositioning forceps 2.

[0023] The repositioning clamp 2 is described below in a space which, from the perspective of a pivot point 4 yet to be described, is spanned by an axial direction 6 pointing out of the image plane, a radial direction 8 running perpendicular to the axial direction 6 in the image plane and a rotation direction 9 running around the axial direction 6.

[0024] The repositioning pliers 2 comprise a first plier section 10 extending in the radial direction 8 and a second plier section 12 extending in the radial direction 8, which is rotatably held on the first plier section 10 about the pivot point 4 in the direction of rotation 9 by means of a lock 14. A first branch 16 with a first handle element 18 is attached to the first plier section 10, while a second branch 20 with a second handle element 22 is attached to the second plier section 12. In the present embodiment, the repositioning pliers 2 are designed as hinged pliers, which is why the branches 16, 20 with the handle elements 18, 22 are attached to the plier sections 10, 12 on a side opposite the lock 14. If the repositioning pliers 2 were designed as bow pliers, the branches 16, 20 with the handle elements 18, 22 would be located between the pliers parts 10, 12 and the lock 14.Although the invention is demonstrated using the example of a jointed pliers, it is not limited to such a pliers.

[0025] The first plier part 10 has, in the radial direction 8, also called longitudinal direction, a first plier head 24 with a first clamping section 26 at an end opposite the lock 14, while the second plier part 12 has, in the radial direction 8, a second plier head 28 at an end opposite the lock 14 with a clamping section 26 in the perspective of the Fig. 1 The second clamping section 30, which is not visible, is present. The two clamping sections 26 and 30 are oriented towards each other in the direction of rotation 9. In this way, a bone can be clamped between the forceps heads 24 and 28 on the clamping sections 26 and 30, which will be discussed in more detail later.

[0026] According to the invention, the first forceps part 10, between its clamping section 26 and the lock 14, comprises a first shoulder 32 extending in the axial direction 6, while the first forceps part 12, between its clamping section 30 and the lock 14, comprises a second shoulder 34 extending in the axial direction 6. A plate for osteosynthesis can be attached to the shoulders 32, 34 in the opposite direction to the radial direction and thus pressed against a bone in the radial direction 2 together with the reduction forceps 2. This will be discussed in more detail later.

[0027] According to the invention, the shoulders 32, 34 are each formed from two projections 36. One of the projections 36 is shown in the perspective of the Fig. 1 not visible and therefore only indicated by dashed lines.

[0028] Each clamping head 24, 28 has a recess 37 extending in its clamping section 26, 30 in the opposite direction to the radial direction 8, which separates the respective clamping section 26, 30 into a first fork tine 38 and a second fork tine 39.

[0029] A locking mechanism 41 is arranged between the jaws 16, 20 and the handle elements 18, 22. The locking mechanism 41 comprises a rack 42 that extends away from the second jaw 20 in the opposite direction of rotation 9, while a locking tooth 43 engaging in the rack 42 extends away from the first jaw 16 in the direction of rotation 9. Between seven and twelve teeth are formed on the rack 42, into which the locking tooth 43 can engage positively in the direction of rotation 9 and thus fix the jaw parts 10, 12 in predetermined angular positions relative to each other.

[0030] Further details of the repositioning pliers 2 are described below using the following examples: Fig. 2 received, which the repositioning pliers 2 from Fig. 1 in an application state in which a bone 44 is clamped between the two clamping sections 26, 30.

[0031] The reduction forceps 2 includes a first spacer 46 on the first forceps part 10 between the first clamping section 26 and the first shoulder 32, while on the second forceps part 12 it includes a second spacer 48 between the second clamping section 30 and the second shoulder 34. The two spacers 46, 48 are designed to hold the bone 44 at a minimum distance 50 in front of the shoulders 32, 34. Thus, the spacers 46, 48 create a space 52 in which the above-described plate for osteosynthesis can not only be received but can also still be correctly positioned after the bone 44 has been clamped.

[0032] In the present embodiment, the spacers 46, 48 are edges 54, which are formed by the clamping sections 26, 30 diverging from the shoulders 32, 34 in the radial direction 8, so that the edge 54 extending in the axial direction 6 is created. The diverging is in Fig. 2 indicated by dashed lines.

[0033] Before discussing the use of the repositioning pliers 2 in more detail, the following will be used to illustrate this. Fig. 3 onto the clamping sections 26, 30 of the repositioning pliers 2 Fig. 1 to be addressed.

[0034] In the present embodiment, the first clamping section 26 has knurled edges 56 on its side adjacent to the bone 44, which prevent the bone 44 from slipping when it is clamped between the clamping sections 26 and 30. In contrast, the surface 58 of the second clamping section 30, which rests against the bone 44, is smooth and allows for precise radial positioning of the bone 44 before clamping. However, both clamping sections 24 and 28 can, in principle, have knurled edges 56, or both clamping sections 24 and 28 can be smooth.

[0035] The two clamping sections 24, 26 are flat, meaning they have a small thickness 60 in the direction of rotation 9. Furthermore, both clamping sections 24 have a sharp point 62 at their ends facing away from the lock 14. In this design, the repositioning forceps 2 can grip the bone 44 in a tissue-sparing manner.

[0036] The use of the repositioning pliers 2 is explained in more detail below using two examples.

[0037] First, the use of the reduction forceps 2 for the operation of an oblique torsional fracture is explained. For this purpose, reference is made to... Fig. 4 Reference is made to the bone 44, which shows an oblique rotational fracture 63.

[0038] In bone 44 of the Fig. 5 It is a femur with a proximal end 64, which is directed towards the upper body and a distal end 65, which is directed towards the foot.

[0039] The operation of this oblique twisting fracture 63 with the repositioning forceps 2 will be described below using the following as an example. Fig. 5 and 6 will be explained in more detail.

[0040] If the two unreferenced bone parts of bone 44 are positioned against each other, bone 44 is formed as shown in Fig. 5 shown, clamped between the pliers heads 24, 28 of the repositioning pliers 2.

[0041] Then, to prepare for screwing in a Fig. 6 A hole is drilled in the pull screw 67 shown using a drill bit 66. The drill bit 66 is positioned between the two fork tines 38, 39 of the first pliers head 24 and driven through the bone 44 in the recess 37 as perpendicular as possible to the oblique fracture 63, so that the drill bit 66 exits the bone 44 outside the second pliers head 28.

[0042] To ensure this as reliably as possible, the fork tines 38, 39 of the second grab head 28 are designed with a width 68 in the axial direction 6, which is smaller than a width 70 of the fork tines 38, 39 of the first grab head 24.

[0043] Following the drilling, the lag screw 67 can then be screwed in. Simultaneously, the plate for osteosynthesis can be inserted into the aforementioned space 52, which is then... Fig. 5 The plate 72 is marked with the reference number 72. After the plate 72 is positioned and fixed with screws that are not further referenced, the reduction forceps 2 can be released. No other tools besides the reduction forceps 2 are necessary for reducing bone 44 and positioning the plate for osteosynthesis during the operation for the oblique rotation fracture 63. Additional tools may be required for other tasks, such as a soft tissue retraction tool.

[0044] Similarly, a transverse fracture 74 can also be operated on using the reduction forceps 2, which is described in the Fig. 7 and 8 is indicated on a forearm bone.

Claims

1. Surgical forceps (2) for holding two bone parts of a broken bone (44) at a bone fracture site (63, 74), comprising a first forceps part (10) extending in a radial direction (8) and a second forceps part (12) extending in the radial direction (8), which is held to be rotatable in a rotational direction (9) about a pivot point (6) via a lock (14) on the first forceps part (10), wherein each forceps part (10, 12) has a forceps head (24, 28) with a clamping section (26, 30) at one end in the radial direction (8), so that the bone parts can be clamped between the forceps heads (24, 28) at the clamping sections (26, 30), each forceps part (10, 12) having a shoulder (32, 34) that extends transversely to the radial direction (8) and transversely to the rotational direction (9) between the clamping section (26, 30) and the lock (14), to which shoulder a plate (72) for osteosynthesis of the bone parts can be applied against the radial direction (8), wherein the shoulders (32, 34) are designed as projections (36) pointing towards each other between the clamping sections (26, 30) and the lock (14), and at least two projections (36) are arranged next to each other to form the shoulders (32, 34) of the forceps parts (10, 12).

2. The surgical forceps (2) according to claim 1, comprising a spacer (46, 48) in at least one clamping section (26, 30) in front of the shoulder (32, 34) as seen in the radial direction (8), which spacer is designed to maintain a predetermined minimum distance (50) between the bone parts and the shoulder (32, 34).

3. The surgical forceps (2) according to claim 2, wherein the spacer (46, 48) is formed by the at least one clamping section (26, 30) diverging in areas in front of the shoulders (32, 34) as seen in the radial direction (8).

4. The surgical forceps (2) according to any one of the preceding claims, wherein each forceps head (24, 28) has a recess (37) in the area of its clamping section (26, 30) which extends in the opposite direction to the radial direction (8) and separates the clamping section (26, 30) into a first fork prong (38) and a second fork prong (39), and wherein the fork prongs (38, 39) of one clamping section (26, 30) are thinner than the fork prongs (38, 39) of the other clamping section (26, 30) as seen transversely to the radial direction (8) and transversely to the rotational direction (9).

5. The surgical forceps (2) according to claim 4, wherein the thinner fork prongs (38, 39) are arranged on a side opposite the screw-in side of a fixation screw (67) for osteosynthesis of the bone parts.

6. The surgical forceps (2) according to claim 4 or 5, wherein the fork prongs (38, 39) are designed to be elastic in the rotational direction (9) with a modulus of elasticity between 30 GPa and 100 GPa.

7. The surgical forceps (2) according to any one of claims 4 to 6, wherein the fork prongs (38, 39) taper in the radial direction (8).

8. The surgical forceps (2) according to any one of the preceding claims, wherein the clamping sections (26, 30) differ in their surface roughness.