Orthopedic distraction device for the distraction of a patient's joint, advantageously the knee

Abstract

The present invention relates to an orthopedic distraction device for distracting a joint (A) of a patient, comprising: - fastening means (2) for fastening said orthopedic distraction device (1) to the bones (S) forming said joint (A), - telescopic linkage means (3) connecting said fastening means (2) and defining a translational degree of freedom (T), - maneuvering means (4) adapted to generate a separation maneuver between said fastening means (2), and - locking means (5) adapted to lock said telescopic linkage means (3) in translation after the creation of said distraction. Figure for the abstract: 5

Description

Title of the invention: Orthopedic distraction device for the distraction of a patient's joint, advantageously the knee Technical field of the invention

[0001] The present invention relates to the technical field of orthopedic devices.

[0002] It relates in particular to orthopedic distraction devices that are adapted to the distraction of a patient's joint, advantageously the knee. Prior art

[0003] Osteoarthritis of a joint, particularly the knee, is a degenerative joint disease characterized by persistent pain and which can lead to loss of function.

[0004] Treatment options are currently limited. And standard treatments can only slow the disease.

[0005] In this context, this disease generally leads to surgery for prosthetic replacement of the joint (for example in the case of bicompartmental joint degeneration).

[0006] There is therefore a definite interest in surgical treatments that can safeguard joints, particularly in young patients with osteoarthritis of the knee.

[0007] In this context, joint distraction could constitute an interesting solution in that it improves joint homeostasis by a temporary mechanical unloading of the joint.

[0008] But current orthopedic distraction devices have various disadvantages in achieving this distraction, namely, in particular, significant bulk, significant discomfort for the patient, external arrangement (leading to a high infection rate due to percutaneous pins) and complexity of placement for the orthopedic surgeon. Presentation of the invention

[0009] In order to remedy the aforementioned drawbacks of the prior art, the present invention proposes an orthopedic distraction device, for the distraction of a patient's joint, advantageously the knee.

[0010] The orthopedic distraction device according to the invention, advantageously internal or external, comprises:

[0011] - means of solidarity, for the solidarity of said distraction device orthopedic with the bones forming said joint,

[0012] which means of securing comprise first means of securing for securing with at least one first bone of said joint, advantageously a tibia, and second means of securing for securing with at least one second bone of said joint, advantageously a femur,

[0013] - telescopic linking means, connecting said fastening means and ending a degree of freedom in translation between the said means of solidarity,

[0014] - means of maneuvering, adapted to generate a maneuver in spacing between said means of securing according to said degree of freedom in translation to create a distraction between the bones of said joint, and

[0015] - locking means, adapted to lock said means in translation telescopic link after the creation of said distraction.

[0016] Such an orthopedic distraction device according to the invention has various advantages, namely in particular reduced bulk, improved comfort for the patient, a possibility of versatile arrangement (possibly external and preferably internal which makes it possible to eliminate the risks of infection related to percutaneous pins) and ease of placement for the orthopedic surgeon.

[0017] Other non-limiting and advantageous features of the product according to the invention, taken individually or in all technically possible combinations, are as follows:

[0018] - the telescopic linking means comprise at least two arms which form together a slide defining said degree of freedom in translation, which arms each have a proximal end which is connected with one of said means of securing; preferably, said at least two arms comprise a first arm, comprising a tubular wall which defines an elongated housing opening at the level of an opening, and a second arm, brought into said elongated housing through said opening and guided in translation along said elongated housing;Preferably, the locking means comprise at least one stop screw which is guided in translation on one of said arms and which cooperates with the other of said arms to ensure said locking, advantageously among an axial stop screw, to maintain the clearance, preferably located parallel to the degree of freedom in translation, advantageously in a bottom of the elongated housing located opposite the opening, and a lateral stop screw, to lock the clearance in translation, preferably located perpendicular to the degree of freedom in translation, advantageously in the tubular wall of the first arm; the operating means advantageously comprise a cam, removable and free in rotation, to generate a relative displacement of said arms by a rotational movement; preferably, the removable cam is assembled on a second arm and cooperates with a first arm;preferably, the removable cam is assembled on the second arm, preferably at the; at the level of its proximal end, and cooperates with the tubular wall of the first arm, on the side of its opening; the operating means advantageously include stop means, to define the end position of rotational travel of said cam, for example a pair of lugs, a first lug carried by said cam and a second lug carried by the tubular wall of the first arm; alternatively and / or complementaryly, the operating means include an axial operating screw which is guided in translation on one of said arms, parallel to the degree of freedom in translation (advantageously in a bottom of the elongated housing located opposite the opening), and which cooperates with the other of said arms to ensure the spreading operation;

[0019] - the locking means include complementary fastening means ment forming a spacer, which are structured to bridge the joint and to attach to an opposite bone of said joint.

[0020] - the means of securing the joint consist of two osteosynthesis plates, namely a first osteosynthesis plate, forming the first means of securing intended to be secured with the first bone of said joint, and a second osteosynthesis plate, forming the second means of securing intended to be secured with the second bone of said joint, which osteosynthesis plates advantageously have holes adapted for the placement of fixing screws; preferably, the proximal end of an arm is monobloc with the associated osteosynthesis plate, or assembled with the osteosynthesis plate, for example by screwing;

[0021] - The orthopedic distraction device includes angulation means for conferring a degree of rotational freedom between said fastening means, perpendicular to said degree of translational freedom, in order to permit distraction with the flexed joint; the angulation means advantageously comprise articulation means which are provided between one of the fastening means and the telescopic linking means, and rotational locking means, adapted to lock said articulation means in rotation after adjustment of said angulation, for example in the form of complementary toothed rings associated with a clamping member.

[0022] The present invention also relates to the orthopedic distraction method, by implementing an orthopedic distraction device according to the invention, which method comprises:

[0023] - a preliminary surgical operation applied to at least one of the bones forming said joint,

[0024] - a step of positioning and securing said distraction device or thepedic joint with the bones forming said joint,

[0025] - possibly an angulation step between the means of securing,

[0026] - a step of creating distraction by implementing the means of maneuver that causes a maneuver in separation of the means of securing,

[0027] - a step of maintaining the distraction, by implementing the means of rusting.

[0028] Of course, the various features, variants, and embodiments of the invention can be combined in various ways, provided they are not incompatible or mutually exclusive. Detailed description of the invention

[0029] In addition, various other features of the invention become apparent from the attached description made with reference to the drawings which illustrate non-limiting embodiments of the invention and where:

[0030] [Fig. 1] is a general view of a first orthopedic distraction device according to the invention;

[0031] [Fig.2] is a general, exploded view of the first orthopedic distraction device according to [Fig.1];

[0032] [Fig.3] is a general view of a first part of the orthopedic distraction device according to [Fig.1], namely a first arm (comprising an elongated housing) with its osteosynthesis plate intended to be secured here with the tibia;

[0033] [Fig.4] is a general view of a second part of the orthopedic distraction device according to [Fig.1], namely a second arm (intended to be brought into the extended housing) with its osteosynthesis plate intended to be secured here with the femur;

[0034] [Fig.5] is a general, perspective view of the orthopedic distraction device according to [Fig.1], secured to the bones forming the joint and prior to the distraction creation step;

[0035] [Fig.6] is a general, front view of the orthopedic distraction device according to [Fig.5];

[0036] [Fig.7] is a general view of the orthopedic distraction device according to [Fig.1], secured with the bones forming the joint and following the distraction creation step;

[0037] [Fig.8] is a general view of a second orthopedic distraction device according to the invention;

[0038] [Fig.9] is a general, exploded view of the second orthopedic distraction device according to [Fig.8];

[0039] [Fig. 10] is a general view of the orthopedic distraction device according to [Fig.8], secured with the bones forming the joint;

[0040] [Fig. 11] is a general view of a third orthopedic distraction device according to the invention;

[0041] [Fig. 12] is a general, exploded view of the third orthopedic distraction device according to [Fig. 11];

[0042] [Fig. 13] is a general view of the orthopedic distraction device according to figures 11 and 12, secured with the bones forming the joint, mounting the implantation before distraction (part A.) and after distraction (part B.);

[0043] [Fig. 14] is a general view of a fourth orthopedic distraction device according to the invention, distinguished from the second orthopedic distraction device by complementary fastening means forming a spacer.

[0044] It should be noted that, in these figures, the structural and / or functional elements common to the different variants may have the same references.

[0045] As described below in connection with the figures, the present invention therefore relates to an orthopedic distraction device 1 which is designed for the distraction of a joint A of a patient, advantageously of the knee.

[0046] By “distraction”, we mean a temporary mechanical discharge of the joint A by creating a separation between the two bones S forming this joint A.

[0047] For example, as illustrated in Figures 5 to 7 or [Fig. 10] in the case of the knee, temporary distraction is implemented between the tibia SI and the femur S2, advantageously with a separation dimension of the order of 5 mm and maintained between 6 and 8 weeks.

[0048] In this case, the orthopedic distraction device 1 advantageously consists of a surgical or implantable orthopedic distraction device 1.

[0049] The orthopedic distraction device 1 is here internal, advantageously implanted under the skin and soft tissues of the patient, which eliminates the risk of infection associated with percutaneous pins.

[0050] Alternatively, the orthopedic distraction device 1 is external, advantageously positioned outside the patient's skin, with fastening means intended to be implanted through the skin and soft tissues.

[0051] In general, according to the invention, the orthopedic distraction device 1 comprises:

[0052] - means of solidarity 2, for the solidarity of the distraction device or thepedic 1 with the S bones forming joint A,

[0053] - telescopic linking means 3, connecting the fastening means 2 and ending a translational degree of freedom T between the fastening means 2,

[0054] - maneuvering means 4, adapted to generate a maneuver in separation between the means of securing 2 according to the degree of freedom in translation T to create the distraction between the bones S of the joint A, and

[0055] - locking means 5, adapted to lock in translation the means of telescopic link 3 after the creation of the desired distraction.

[0056] In particular, the translational degree of freedom T advantageously extends perpendicularly with respect to the folding axis of the joint A or with respect to the joint line. Means of solidarity

[0057] The means of solidarity 2 include:

[0058] - initial means of solidarity 21 for solidarity with at least one first bone SI of joint A (advantageously a tibia for the knee), and

[0059] - second means of solidarity 22 for solidarity with at least one second bone S2 of joint A (advantageously a femur for the knee).

[0060] Preferably, the fastening means 2 consist of two osteosynthesis plates 2, namely:

[0061] - a first osteosynthesis plate 21, forming the first means of solida risation 21 intended to be joined to at least one first bone SI of joint A, and

[0062] - a second osteosynthesis plate 22, forming the second means of solida risation 22 intended to be joined with at least one second bone S2 of the joint A.

[0063] Generally, for the knee, the first means of securing 21 are adapted to securing with the tibia, forming tibial means of securing 21; and the second means of securing 22 are adapted to securing with the femur, forming femoral means of securing 22.

[0064] Alternatively, as illustrated in Figures 8 and following, the fastening means 2 are adapted to an assembly reversed with respect to Figures 5 and following:

[0065] - the first means of solidarity 21 are adapted to solidarity with a first bone SI which here is the femur, forming means of femoral 21 solidarity, and

[0066] - the second means of solidarity 22 are adapted to solidarity with a second bone SI which is here the tibia, forming means of tibial solidarity 22.

[0067] In general, osteosynthesis plates 2 advantageously include orifices 23 adapted for the placement of fixation screws V in bone S.

[0068] Preferably, the orifices 23 are arranged so that the fixing screws V preserve the joint surfaces and the fixing screws V diverge to increase the anchoring force.

[0069] In a conventional manner, such osteosynthesis plates 2 comprise:

[0070] - a rear face, advantageously anatomically shaped and intended to come into contact with the bone, and

[0071] - a front, opposite face.

[0072] The thickness of such an osteosynthesis plate 2 is advantageously a few millimeters.

[0073] More generally, as illustrated in particular in figures 5 to 7, the means of securing 2 are advantageously shaped for fixation on the medial and / or lateral and / or anteromedial and / or anterior faces of the bones S of the joint A. Telescopic linking means

[0074] The telescopic linkage means 3 advantageously comprise at least two arms 31, 32 which together form a slide defining the translational degree of freedom T.

[0075] The arms 31, 32 each have a proximal end 311, 321 which is connected (or joined) with one of the fastening means 2.

[0076] In this case, a first arm 31 cooperates with the first means of securing 21 (figures 2 and 3, or figures 8 and following).

[0077] The first arm 31 (advantageously in the form of a sleeve or sheath) advantageously comprises a tubular wall 313 which defines an elongated housing 314, advantageously a blind housing, opening at the level of an opening 315.

[0078] The elongated housing 314 advantageously consists of a blind housing, comprising a bottom 316 located opposite the opening 315.

[0079] The elongated housing 314 extends advantageously coaxially with respect to the translational degree of freedom T.

[0080] A second arm 32, cooperating with the second means of securing 22, is visible in more detail in figures 2 and 4 or in figures 8 and following.

[0081] The second arm 32 is intended to be brought into the elongated housing 314 of the first arm 31, through its opening 315 and guided in translation along the elongated housing 314 (coaxially to the translational degree of freedom T).

[0082] In particular, the cross-section of the second arm 32 corresponds, to the extent of play, to the cross-section of the elongated housing 314 of the first arm 31 so as to ensure the guidance in relative translation between these two arms 31, 32 according to the degree of freedom in translation T.

[0083] In addition, the second arm 32 advantageously includes a visual marking 325 which is useful for observing / measuring the displacement of this second arm 32 relative to the opening 315 of the first arm 31, corresponding to the distraction applied to the joint A.

[0084] Generally speaking, for the knee, the first arm 31 cooperates, for example, with first means of "tibial" stabilization 21 and the second arm 32 cooperates with second means of solidarity 22 “femoral” (figures 1 to 7 for example).

[0085] Alternatively, in the case of an assembly reversed to that illustrated in Figures 5 and following (Figures 8 and following), the first arm 31 cooperates with first means of securing 21 “femoral” and the second arm 32 cooperates with second means of securing 22 “tibial”.

[0086] In general, the telescopic linking means 3 can be made in one piece (figures 9 to 11), or assembled (figures 1 to 8 or figures 11 and 12), with the fastening means 2.

[0087] In practice, the proximal end 311, 321 of an arm 31, 32 is advantageously:

[0088] - monobloc with the associated osteosynthesis plate 21, 22 (Figures 9 to 11), or

[0089] - assembled with the associated osteosynthesis plate 21, 22, for example by screwing (figures 1 to 8 or figures 11 and 12).

[0090] For example, according to figures 1 to 7 or 11 and 12, the proximal end 311 of the first arm 31 is monobloc with the first osteosynthesis plate 21. The proximal end 321 of the second arm 32 is assembled with the associated second osteosynthesis plate 22.

[0091] In general, the assembly means 7, 9 (between the proximal end 321 of the second arm 32 and the associated second osteosynthesis plate 22) are advantageously chosen from:

[0092] - articulation means 7 forming part of angulation means 6 described by the continued in relation to figures 1 to 7, conferring a degree of rotational freedom between the proximal end 321 of the second arm 32 and the associated second osteosynthesis plate 22, or

[0093] - fixed assembly means 9, described subsequently in relation to figures 11 to 13, defining a precise angular position between the second arm 32 and the associated second osteosynthesis plate 22.

[0094] For the "fixed assembly means 9" embodiment, the second osteosynthesis plate 22 advantageously includes a location 225 intended to receive the proximal end 321 of the second arm 32 and to ensure the angular locking of this second arm 32.

[0095] Generally, to perform the assembly, the proximal end 321 of the second arm 32 is advantageously:

[0096] - superimposed with a front face of the second osteosynthesis plate 22, then

[0097] - assembled by a clamping element 71,91, for example a screw, which is attached to the through a pair of aligned orifices 72, 92 which are provided respectively in the arm 32 (at the level of its proximal end 321) and in the associated osteosynthesis plate 22.

[0098] According to the embodiment illustrated in Figures 1 to 7 or Figures 11 and 12, the second osteosynthesis plate 22 preferably consists of an osteosynthesis plate adapted to be brought onto an SI bone posterior to a surgical procedure applied to said S2 bone (for example, a fracture osteosynthesis or a corrective osteotomy, as illustrated in [Fig. 13]).

[0099] Alternatively, according to figures 8 to 10, the proximal end 311 of the first arm 31 is monobloc with the first osteosynthesis plate 21. The proximal end 321 of the second arm 32 is monobloc with the associated second osteosynthesis plate 22. Means of maneuver

[0100] According to a first embodiment illustrated in figures 1 to 7, the maneuvering means 4 advantageously consist of a cam 41, here removable and free in rotation, to generate a relative displacement of the arms 31, 32 by its rotational movement.

[0101] Preferably, the removable cam 41 is temporarily assembled on the second arm 32, preferably at its proximal end 321.

[0102] And this cam 41 cooperates with the tubular wall 313 of the first arm 31, on the side of its opening 315.

[0103] Such a removable cam 41 is particularly interesting for limiting the bulk of the orthopedic distraction device 1, especially when it is implanted internally.

[0104] This “removable” structure also allows the cam 41 to be chosen from a range of cams 41 which have respective distraction values ​​and which allow for taking into account a possible variation in initial length at the level of the telescopic linkage means 3.

[0105] In this case, the cam 41 advantageously consists of an external profile type cam whose rotation around its axis of rotation 41' generates a radial force (perpendicular to the axis of rotation 41') between the arms 31, 32.

[0106] For this purpose, the cam 41 has an external profile 411 which is curved and which moves progressively away from the axis of rotation 41'.

[0107] For its rotational guidance, the cam 41 advantageously comprises a cylindrical section 412 which is intended to cooperate with the second arm 32 to define the degree of rotational freedom.

[0108] In this case, the cylindrical section 412 is intended to fit into a housing located at the proximal end 321 of the second arm 32.

[0109] This housing is here formed by the female head 711 of the aforementioned clamping member 71.

[0110] For its rotational operation, the cam 41 advantageously includes a gripping member 413, here centered on the rotation axis 41', adapted to cooperate with an operating tool.

[0111] This grasping organ 413 is presented here in the form of a hexagonal head.

[0112] Preferably, the maneuvering means 4 include means of stops 42, to define the end position of rotation of the cam 41 during distraction.

[0113] For example, the stop means 42 include a pair of lugs 421, 422 intended to cooperate in the rotational end-of-stroke position of the cam 41.

[0114] In this case, the pair of spurs 421, 422 comprises:

[0115] - a first lug 421 carried by the cam 41, at the end of its outer profile 411, And

[0116] - a second lug 422, here projecting, carried by the tubular wall 313 of the first arm 31 (on the side of opening 315).

[0117] The second lug 422 here sandwiches the cam 41 (at its outer profile 411) with the second arm 32 so as to help retain the cam 41 during its rotation. In other words, the second lug 422 defines a groove with the second arm 32 which is designed to receive and guide the outer profile 411, to help retain the cam 41.

[0118] The second lug 422 can possibly serve as a reference point with respect to the visual marking 325, so as to verify the dimension in distraction applied to the joint A.

[0119] According to a second embodiment illustrated in particular in Figures 8 and following, the operating means 4 comprise an axial operating screw 45 which is guided in translation on one of the arms 31, parallel to the translational degree of freedom T.

[0120] Such an axial operating screw 45 has the advantage of eliminating additional instruments compared to a cam 41, thus simplifying the operating technique.

[0121] Preferably, this axial operating screw 45 is implanted parallel to the translational degree of freedom T, advantageously in the bottom 316 of the elongated housing 314 of the first arm 31.

[0122] Preferably, this axial operating screw 45 is intended to travel in translation along the translational degree of freedom T.

[0123] This axial operating screw 45 advantageously comprises two ends ( [Fig.9]):

[0124] - a first end 451, located within the elongated housing 314 and intended to to press against an end wall 323 of the second arm 32 for its translational movement, and

[0125] - a second end 452, located outside the elongated housing 314 and forming a rotating maneuvering head.

[0126] Generally, the rotational movement of the axial operating screw 45 (tightening or loosening) generates a movement of the arms 21, 22 relative to each other. the other, leading to a maneuver in separation between the means of solidarity 2 according to the degree of freedom in translation T to create a distraction between the bones S of the joint A. Locking methods

[0127] The locking means 5 advantageously include at least one stop screw 51, 52 which is guided in translation on one of the arms 31, 32 and which cooperates with the other of the arms 31, 32 to ensure this locking.

[0128] For example, the locking means 5 include at least one stop screw 51, 52 among:

[0129] - an axial stop screw 51, to maintain the applied distraction, and

[0130] - a lateral stop screw 52, ​​to lock the play in translation.

[0131] The axial stop screw 51 ensures an end-of-stroke stop of the first arm 31 relative to the second arm 32.

[0132] Preferably, this stop screw 51 is implanted parallel to the translational degree of freedom T, advantageously in the bottom 316 of the elongated housing 314 of the first arm 31 to serve as a support stop with an end wall 323 of the second arm 32.

[0133] Generally, according to the first embodiment illustrated in Figures 1 to 7, the stop screw 51 is advantageously identical to the axial operating screw 45 according to Figures 8 and following, to form operating means 4 adapted to be operated in addition (or combination) with the cam 41 in order to adjust the distraction.

[0134] The lateral stop screw 52 is preferably implanted perpendicular to the translational degree of freedom T.

[0135] This lateral stop screw 52 is, for example, located:

[0136] - in the tubular wall 313 of the first arm 31, so as to exert a com pressure on a lateral wall 324 of the second arm 32 (figures 1 to 7), or

[0137] - in the second arm 32, within a threaded through orifice 327 so as to come exert a frictional pressure on the first arm 31 (figures 8 to 10).

[0138] For a lateral stop screw 52 carried by the second arm 32, said lateral stop screw 52 advantageously comprises:

[0139] - a support plate 521, intended to exert the friction force on the wall tubular 313 of the first arm 31, and

[0140] - a control head 522, advantageously accessible through a window 317 formed in the tubular wall 313 of the first arm 31.

[0141] Alternatively or complementarily, as illustrated in [Fig. 14], the locking means 5 advantageously comprise complementary fastening means 55 forming a spacer, which are structured to bridge the joint A and to to attach to a bone SI, S2 opposite this joint A.

[0142] In other words, the additional fastening means 55 advantageously consist of a spacer which has a fixed length and which is fastened to the two bones SI, S2 forming the joint A.

[0143] As further developed, this additional fixation is implemented after the distraction step (after the translation).

[0144] Such means of complementary securing 55 can be implemented in the different embodiments according to the invention.

[0145] In other words, the complementary solidarity means 55 advantageously include complementary solidarity means 55, equipping:

[0146] - the first means of solidarity 21 and / or the first arm 31 cooperating with a bone S, for the connection with another bone S of joint A ([Fig. 14]), and / or

[0147] - the second means of solidarity 22 and / or the second arm 32 cooperating with a bone S, for the connection with another bone S of the joint A (not shown).

[0148] For example, as illustrated in [Fig. 14], the complementary fastening means 55 extend from the first arm 31 cooperating with a bone S2, in particular from its tubular wall 313. These complementary fastening means 55 bridge the joint A and are fixed on an opposite bone SI of this joint A.

[0149] The additional securing means 55 advantageously include at least one arm 551 (or strut), which is intended to span or bridge the joint A.

[0150] This arm 551 advantageously includes at least one orifice 552 for the installation of a fixing screw 553 which is fixed to the opposite bone segment SI.

[0151] This arm 551 advantageously has a fixed length.

[0152] This arm 551 is preferably diverging with respect to the translational degree of freedom T, from its upstream end 555 (here monobloc with the first arm 31). Angulation methods

[0153] According to the invention, as illustrated in Figures 1 to 7, the orthopedic distraction device 1 advantageously includes angulation means 6 to confer a degree of rotational freedom between the fastening means 2, along an axis of rotation R which extends perpendicularly to the translational degree of freedom T.

[0154] This technical feature then allows, if necessary, a distraction with the joint A flexed.

[0155] According to a preferred embodiment, illustrated in [Fig.2], the angulation means 6 comprise:

[0156] - means of articulation 7 which are provided between one of the means of solidarity adjustment 2 and telescopic linkage means 3, to allow relative angulation around the axis of rotation R, and

[0157] - rotation locking means 8, adapted to rotationally lock the means of articulation 7 after adjustment of the angulation around the axis of rotation R.

[0158] In this case, the articulation means 7 define the aforementioned axis of rotation R.

[0159] The articulation means 7 include, for example, a clamping member 71, for example a screw, which is brought through a pair of orifices 72 which are provided respectively in an arm 32 (at the level of its proximal end 321) and in its associated osteosynthesis plate 22.

[0160] The rotation locking means 8 consist for example of a pair of toothed rings 81, complementary and frontal, forming a toothed wheel, which cooperates with the clamping member 71.

[0161] These toothed rings 81 are arranged around the aforementioned orifices 72 and at the level of the opposite surfaces to engage them when tightening the clamping member 71.

[0162] In other words, tightening the clamping member 71 allows the toothed rings 81 to mesh, causing a rotational lock between the arm 32 and its associated osteosynthesis plate 22. Orthopedic distraction procedure

[0163] An orthopedic distraction method, by implementing the orthopedic distraction device 1 according to the invention, is described below in relation to figures 5 to 7.

[0164] The orthopedic distraction method 1 comprises:

[0165] - a positioning and securing step of the distraction device or thepedic 1 with the S bones forming the A joint (figures 5 and 6),

[0166] - possibly, and if necessary, an angulation step between the means of solida Risation 2,

[0167] - a step of creating the distraction, advantageously of the order of 5 mm, by the implementation of the maneuvering means 4 which causes a maneuver in separation of the securing means 2 (from [Fig.6] to [Fig.7]), then

[0168] - a step of maintaining distraction, by implementing means of rusting 5.

[0169] The orthopedic distraction device 1 according to the invention has the advantage of allowing here a positioning and securing step internally, advantageously under the skin and soft tissues.

[0170] In this case, the orthopedic distraction device 1 is positioned and locked on either side of the joint A by means of screws V attached to the two osteosynthesis plates 2.

[0171] According to the embodiment illustrated in figures 1 to 7, an angulation step is permitted by the angulation means 6, by acting on the rotation locking means 8 (here tightening / loosening of the clamping member 71).

[0172] According to the first embodiment, the removable maneuvering means 4 can here be temporarily brought back for the implementation of the distraction creation step, and then can be removed following the distraction maintenance step.

[0173] If necessary, the cam 41 is operated in rotation, preferably to the end-of-stroke position in rotation, to generate the desired distraction.

[0174] The distraction maintenance step is here ensured by the two stop screws 51 which are operated successively:

[0175] - the axial stop screw 51, to maintain the applied distraction, then

[0176] - the lateral stop screw 52, ​​to lock the play in translation.

[0177] The cam 41 can in particular be removed after tightening the axial stop screw 51.

[0178] According to the second embodiment (Figures 8 and following), the axial operating screw 45 is operated in rotation, preferably face-on, to generate the desired distraction.

[0179] The distraction maintenance step is here ensured by a combined action of the axial operating screw 45 and the lateral stop screw 52, ​​intervening in the locking of the translational play.

[0180] Where appropriate, according to the fourth embodiment described in connection with [Fig. 14], the step of maintaining distraction is further ensured by the implementation of the means of complementary solidarity 55.

[0181] These additional support means 55 are intended to bridge the joint A by attaching to the opposite bone segment.

[0182] Once joined, these additional joining means 55 provide a strut (or support leg) function between the two bones SI, S2 forming the joint A.

[0183] In addition, preferably, the method may include a preliminary surgical operation applied to at least one of the bones SI, S2 forming the joint A, for example a fracture osteosynthesis or a corrective osteotomy.

[0184] This preliminary surgical operation is in particular made possible by the orthopedic distraction device 1 according to figures 1 to 7, or figures 11 and 12.

[0185] In this sense, a prior surgical operation C (for example, a fracture osteosynthesis or a corrective osteotomy) is performed on the first bone SI of the joint A (advantageously a tibia for the knee).

[0186] This preliminary surgical operation is stabilized by the implantation of the second means of securing 22 on the first bone SI ([Fig. 13], part A).

[0187] The other components of the orthopedic distraction device 1 are then reported to carry out the positioning and securing step of the orthopedic distraction device 1 with the bones S forming the joint A ([Fig. 13], part B).

[0188] In particular, the proximal end 321 of the second arm 32 is secured with the second means of securing 22 secured with the first bone SI by means of the assembly means 7, 9. And the first means of securing 21 carrying the first arm 31 are secured with the second bone S2.

[0189] The practitioner can then continue the procedure:

[0190] - a step of creating the distraction, advantageously of the order of 5 mm, by the implementation of maneuvering means 4 which causes a maneuver in separation of the securing means 2, then

[0191] - a step of maintaining distraction, by implementing means of rusting 5.

[0192] Generally, at the end of the distraction period (usually after a few weeks), the orthopedic distraction device 1 is intended to be subjected to an ablation procedure.

[0193] Preferably, the ablation process is carried out in the opposite direction to the Orthopedic distraction procedure 1:

[0194] - a step of unlocking the distraction, by unlocking the means of locking 5,

[0195] - a step of disengaging the orthopedic distraction device 1 from to the S bones forming joint A.

[0196] Of course, various other modifications can be made to the invention within the scope of the annexed claims.

Claims

Demands

1. An orthopedic distraction device for the distraction of a patient's joint (A), advantageously the knee, characterized in that said orthopedic distraction device (1) comprises: - fastening means (2) for fastening said orthopedic distraction device (1) to the bones (S) forming said joint (A), which fastening means (2) comprise first fastening means (21) for fastening to at least one first bone (S1) of said joint (A), and second fastening means (22) for fastening to at least one second bone (S2) of said joint (A), which fastening means (2) consist of two osteosynthesis plates (2), namely a first osteosynthesis plate (21), forming the first fastening means (21) intended to be fastened to the first bone (S1) of said joint (A), and a second plate of osteosynthesis (22),forming the second fastening means (22) intended to be fastened to the second bone (S2) of said joint (A), - telescopic connecting means (3), linking said fastening means (2) and defining a translational degree of freedom (T) between said fastening means (2), - maneuvering means (4), adapted to generate a spreading maneuver between said fastening means (2) according to said translational degree of freedom (T) to create a distraction between the bones (S) of said joint (A), and - locking means (5), adapted to lock said telescopic connecting means (3) in translation after the creation of said distraction.

2. Orthopedic distraction device, according to claim 1, characterized in that the telescopic linking means (3) comprise at least two arms (31, 32) which together form a slide defining said translational degree of freedom (T), which arms (31, 32) each have a proximal end (311, 321) which is connected with one of said joining means (2).

3. Orthopedic distraction device, according to claim 2, ca- characterized in that said at least two arms (31, 32) comprise: - a first arm (31), comprising a tubular wall (313) which defines an elongated housing (314) opening at the level of an opening (315), and - a second arm (32), brought into said elongated housing (314) through said opening (315) and guided in translation along said elongated housing (314).

4. Orthopedic distraction device, according to any one of claims 2 or 3, characterized in that the operating means (4) comprise a cam (41), removable and free in rotation, for generating a relative displacement of said arms (31, 32) by a rotational movement, preferably, which removable cam (41) is assembled on a second arm (32) and cooperates with a first arm (31).

5. Orthopedic distraction device, according to any one of claims 2 to 4, characterized in that the operating means (4) comprise an axial operating screw (45) which is guided in translation on one of said arms (31), parallel to the translational degree of freedom (T), and which cooperates with the other of said arms (32) to ensure the spreading maneuver, where appropriate advantageously in a bottom (316) of the elongated housing (314) located opposite the opening (315) according to claim 3.

6. An orthopedic distraction device, according to any one of claims 2 to 5, characterized in that the locking means (5) comprise at least one stop screw (51, 52) which is guided in translation on one of said arms (31) and which cooperates with the other of said arms (32) to ensure said locking, advantageously among: - an axial stop screw (51), to maintain the distraction, preferably implanted parallel to the translational degree of freedom (T), where appropriate advantageously in a bottom (316) of the elongated housing (314) located opposite the opening (315) according to claim 3, and - a lateral stop screw (52), to lock the translational play, preferably implanted perpendicular to the translational degree of freedom (T), advantageously in the tubular wall (313) of the first arm (31).

7. An orthopedic distraction device, according to any one of claims 2 to 6, characterized in that the proximal end (311, 321) of an arm (31, 32) is: - monobloc with the associated osteosynthesis plate (2), or - assembled with the osteosynthesis plate (2).

8. Orthopedic distraction device, according to any one of claims 1 to 7, characterized in that the locking means (5) comprise complementary securing means (55) forming a spacer, which are structured to bridge the joint (A) and to be fixed on a bone (SI, S2) opposite said joint (A).

9. Orthopedic distraction device, according to any one of claims 1 to 8, characterized in that it comprises angulation means (6) for conferring a rotational degree of freedom between said fastening means (2), perpendicular to said translational degree of freedom (T), in order to permit distraction with the joint (A) flexed.

10. Orthopedic distraction device, according to claim 9, characterized in that the angulation means (6) comprise: - articulation means (7) which are provided between one of the securing means (2) and the telescopic linking means (3), and - rotation locking means (8), adapted to rotationally lock said articulation means (7) after adjustment of said angulation.

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