Intramedullary nailing device for the tibia

Abstract

The present invention relates to a tibial intramedullary nailing device comprising a framework frame consisting of vertical supports (2), longitudinal supports (3, 4) and lateral horizontal supports (5, 5', 5", 6, 6) and a guide (21) slidably coupled to the longitudinal horizontal support (4) of the device. The guide (21) comprises a first finder (11) for laterally adjusting the position of the retraction needle (20), a second finder (13) for vertically adjusting the position of the retraction needle (20) and for passing the retraction needle (20) laterally through the tibia, and mounting arms (22, 24) attached to the frame, the mounting arms (22, 24) being attached to the end of the retraction needle (20) on the lateral side of the tibia using the guide (21).

Description

Technical Field

[0001] The present invention relates to an intramedullary nail fixation device for the tibia.

Background Art

[0002] Tibial fractures are injuries that are particularly common among young and middle-aged adults. The fracture can be caused by a fall, an accident, or a strong blow to the leg. Treatment of a tibial fracture usually includes realignment, that is, placing the ends of the bones at the fracture site in a predetermined position.

[0003] Intramedullary nail fixation is the most commonly used method for treating tibial fractures, which means inserting a metal nail into the medullary cavity of the tibia. The nail is placed into the medullary cavity through the tendon under the patella. Once the nail is in place, screws are inserted at both ends to keep the bone in the desired position.

[0004] The role of the intramedullary nail for the tibia is to maintain the separated bone parts in an aligned state so that the ends of the bones at the fracture site of the tibia are aligned in a straight line, and thus to enable the tibia to ossify in the correct position.

[0005] Traditionally, since the intramedullary nail is inserted into the bone from the upper part of the tibia, according to research, it causes the so-called "anterior knee pain" symptom of pain in the front of the knee after surgery in a considerable number of patients.

[0006] Furthermore, in the currently commonly used surgical method, the leg of the patient to be operated on is placed at an angle of more than 90 degrees with respect to a round support. Also, to align the damaged ends of the tibia, the leg is pulled obliquely forward and downward. This procedure may compress the nerve behind the knee, increasing the risk of nerve injury. When using a wedge pillow, an assistant, that is, another surgeon, is required to keep the leg in a predetermined position. The job of the assistant in this procedure is to maintain the necessary pulling force on the leg so that the leg cannot be moved when the ends of the bone are aligned and a space for the intramedullary nail is drilled in the bone.

[0007] There are two known versions of intramedullary nailing of the tibia. The first method uses a traction table designed for the procedure, but it has many problems. For example, surgical preparation is time-consuming and imaging is difficult. Incorrect patient posture can lead to nerve damage, and this method requires the surgeon to work in an ergonomically challenging working position. The second method involves intramedullary nailing on a standard operating table using a wedge pillow designed for intramedullary nailing of the tibia. The problem with this procedure is that the leg moves continuously, requiring another orthopedic surgeon or trauma specialist to support the leg during the procedure. Also, this wedge pillow procedure, which involves large leg movements, is prone to causing tissue and vascular damage to the calf muscles.

[0008] In commonly used surgical methods, a needle is also inserted into the heel bone and attached to a traction device. The heel bone region contains important nerve structures and soft tissues that are susceptible to damage.

[0009] Patent Document 1 is cited as prior art, and it discloses a device for intramedullary nailing of the tibia, which allows for adjustment of the bone length by inserting a needle through the bone. [Prior art documents] [Patent Documents]

[0010] [Patent Document 1] Chinese Patent Application Publication No. 110537964 Specification [Overview of the project] [Problems that the invention aims to solve]

[0011] The objective of this invention is to provide a device that enables safer and more patient-friendly intramedullary nailing surgery for the tibia. [Means for solving the problem]

[0012] The intramedullary nailing device for the tibia according to the present invention comprises a frame of a framework consisting of a vertical support, a longitudinal horizontal support, and a transverse horizontal support. The device also comprises a guide slidably coupled to the longitudinal horizontal support of the device. The guide comprises a first finder for adjusting the position of the traction needle (20) in the lateral direction, and a second finder for adjusting the position of the traction needle vertically and passing the traction needle through the tibia laterally. The device also comprises a mounting arm attached to the frame, to which the lateral end of the traction needle for the tibia is attached.

[0013] Preferred embodiments of the present invention have the features described below, which are disclosed in the dependent claims.

[0014] The device includes a first mounting arm for a traction needle in the lower part of the tibia. The first mounting arm is attached to a lateral support that is slidably mounted between some of the longitudinal supports in the frame. The lateral support, which is slidably mounted between the longitudinal supports, slides along the longitudinal supports by a guide carriage such as a traction trolley.

[0015] The longitudinal horizontal support typically consists of an upper support and a lower support, in which case the lower support preferably functions as a sliding rail for the guide carriage.

[0016] The device also includes a second attachment arm for a traction needle in the upper part of the tibia. The second attachment arm is mounted within the frame to a lateral support that is fixed (i.e., immovably) attached between two vertical supports.

[0017] The lateral support can rotate forward and backward, which means that the mounting arm attached to the lateral support can rotate to both forward and backward positions.

[0018] The guide comprises a first finder with attachment means for passing traction needles through the lower and upper parts of the tibia, respectively, and a second finder with attachment means for attachment.

[0019] A vertical height adjustment unit is connected to a guide, which is mounted at its upper end to the same mounting means or a separate mounting element within the guide, and at its lower end to a second mounting means. The first and second finders are located within the same guide and are adjustable to different heights.

[0020] The mounting arms are attached to the lateral support by a ring that surrounds them. The ring has screw holes at the bottom of the groove into which screws can be tightened to hold the mounting arms in place.

[0021] The device according to the present invention can be called a tibial traction and repositioning device and was developed for "suprapatellar" (i.e., performed below the patella) intramedullary nailing of the tibia in adult patients. The biggest difference from existing surgical methods is that this procedure is performed using a standard operating table, so the leg is fixed between the tibial traction and repositioning device from the upper and lower parts of the tibia, so the leg is only slightly bent, and the device is supported by itself on the operating table. Conventional methods use a traction table designed for the purpose (e.g., Ossano traction table) or a wedge pillow used on a standard operating table.

[0022] In the tibial traction and repositioning device according to the present invention, the knee is positioned at an angle of approximately 5 to 10 degrees, thereby preventing nerve damage to the patient's nerves in the "flexion" portion behind the knee during surgery, as pressure is not applied to the back of the leg. The device is equipped with needle attachment arms for needles on the upper and lower parts of the tibia. The needle attachment arm on the lower part of the tibia is on a sliding rail, so the end of the tibia can be aligned by pulling the lower attachment mechanism. The needle attachment arm on the upper part of the tibia does not move in the longitudinal direction of the device.

[0023] In the present invention, the tibia is attached to the tibial traction and realignment device by thin needles. The needles are inserted into the bone from the upper and lower parts of the fractured tibia and from the side of the tibia. The advantage of this new device is that the needles are inserted into the already damaged bone, protecting the intact bone, nerves, and tissues from unnecessary damage. The medical technology device according to the present invention enables a safer and more cost-effective intramedullary nailing operation of the tibia. In the conventional method, when performing intramedullary nailing of the tibia on the operating table, an additional surgeon is required to apply sufficient traction to the leg and keep the leg in a predetermined position during the procedure.

[0024] The present invention will be described in more detail below using one embodiment and the associated figures, as well as the method of using that embodiment.

Brief Description of the Drawings

[0025] [Figure 1] The traction and realignment device according to the present invention for intramedullary nailing of the tibia is shown.

Embodiments for Carrying Out the Invention

[0026] Figure 1 shows the device according to the present invention for traction and realignment of the tibia for intramedullary nailing of the tibia, where the intramedullary nail is inserted into the tibia.

[0027] A tibial fracture suffered by a patient due to trauma is treated by inserting an intramedullary nail into the tibia and leaving the intramedullary nail in place if tibial repair is required. This applies when the bone is fractured into two or more parts and the fracture does not reach the joint surface.

[0028] The patient (not shown) lies supine on an operating table (not shown) throughout the operation. For this procedure, the patient is anesthetized. Then, the patient is covered with a sterile cover, and the leg to be operated on remains exposed.

[0029] The apparatus according to the present invention has a rectangular base 1. The base 1 is a bottom plate, a rectangular plate with a central opening to enable imaging so that no metal is present in the imaging area when imaging from above relative to the leg. The purpose of the base 1, i.e., the bottom plate, is to stabilize the apparatus and prevent it from being pressed into the soft mat of the operating table. A vertical support 2 can be attached to the base 1.

[0030] Two upper supports 4 are attached to a total of four vertical supports 2 by knurled head screws 19 at each corner of the base 1, at approximately tibia height when the knee is raised to an angle of about 10 degrees. The two upper supports 4 are attached to both sides of the base 1 by extending along the longitudinal sides of the base 1. Additionally, two lower supports 3, extending along the longitudinal sides of the base 1, are attached at approximately ankle height.

[0031] For example, the lateral supports 5, 5', 5'', and 6, which are attached to the vertical support 2 at approximately ankle height by screws 15, are joined on the other two sides of the base 1 by extending along their shorter sides. The device further includes a lateral support 6' between the lower supports 3, which moves along the lower supports 3 on a guide carriage 8 such as a traction trolley. Thus, the lower supports 3 are configured to function as sliding rails for the guide carriage 8 and to support the device.

[0032] The vertical support 2, upper support 4, lower support 3, and lateral supports 5, 5', 5”, 6, and 6' can be, for example, guides, pipes or rods, or corresponding supports or shafts.

[0033] In Figure 1, the lowest lateral supports 5' and 5'' are slightly lower than the lower support 3, while lateral supports 5 and 6 are slightly higher than the lower support 3. Lateral support 6 is depicted discontinuously in Figure 1 for illustrative purposes to make it easier to understand how the mounting arm 24 is attached to it, which will be discussed later. Lateral support 6 is a control shaft, and its function will be described below. In Figure 1, lateral supports 5, 5', 5'', and 6 are attached to the vertical support 2 by fastening screws 15 or another mounting method. The purpose of the holes (unsigned) in the vertical support 2 is to reduce weight, as the vertical support 2 is heavy. Lateral supports 5, 5', 5'', and 6 are in fixed positions, while lateral support 6' moves along the lower support 3 as described above.

[0034] The device according to the present invention is positioned under the leg to be operated on, with the patient lying on their back and the leg facing the shaft 5 on the device.

[0035] Even after this, it is still necessary to position the leg to be operated on precisely, or more precisely, in its designated position on the device in order to stabilize the fractured bone.

[0036] For stabilization, so-called traction needles are inserted laterally into the tibia, both at a point below the patella near the patella in the upper part of the tibia, and at the ankle in the lower part of the tibia. The insertion of the traction needles into the tibia is performed using a guide attached to an upper support 4. The guide 21 moves along another upper support 4.

[0037] After surgery, the traction needle is removed before the surgical wound closes. However, before inserting the traction needle, it is necessary to ensure that the guide 21 for inserting the traction needle is in the correct position relative to the bone, both vertically and laterally. The position of the guide 21 is checked with an X-ray device and adjusted as needed.

[0038] The guide 21 includes separate lateral arms 11, 13 of different heights that move unobstructedly within the upper support 4 from the ankle to the knee and function as finders for positioning the traction needle. Since these lateral arms 11, 13 are directionally controlled and not intended to rotate, their shape is preferably other than circular, for example, square, and therefore locks better against the sleeve in the lateral direction to prevent rotation.

[0039] Positioning of the first traction needle Guide 21 includes a first sleeve 25 through which a first lateral arm 11 extends laterally to an upper support 4, and at the end of the lateral arm 11, a traction needle 20 is indicated at position A, where its lateral position is adjusted. The traction needle 20 is marked 20A when it is at position A in the sleeve 30 at the end of the lateral arm 11. The lateral arm 11 functions as an upper finder for the subsequent insertion of the traction needle 20. The purpose of the lateral arm 11, i.e., the upper finder, is to adjust the lateral position of Guide 21, which is done by irradiating it with X-rays from above. The actual insertion of the traction needle 20 through the tibia has not yet been performed at position A.

[0040] Guide 21 includes a second sleeve 9 that passes through the height adjustment section 12, and the sleeve 9 is located above the height adjustment section 12. A rod or the like can be used as the height adjustment section 12. Below the height adjustment section 12 is a third sleeve 10 through which the height adjustment section 12 of guide 21 passes. In this way, the height adjustment section 12 connects the lower finder and the upper finder (i.e., the lateral arms 11 and 13).

[0041] The second lateral arm 13 passes through the sleeve 10 and laterally through the upper support 4, to which the traction needle 20 is attached by a connecting component 31, which includes a sleeve 23. In other words, the traction needle is moved from the lateral arm 11 to the lateral arm 13. The lateral arm 13 functions as a lower finder for the same traction needle 20 that was previously used to determine the position of the traction needle 20 relative to the articular surface of the upper tibia, i.e., its position in the lateral direction is confirmed, and then it is moved to the sleeve 23 of the lateral arm 13.

[0042] Therefore, after the lateral adjustment of the guide 21, if the traction needle 20 is confirmed to be at the correct height by X-ray imaging from the lateral direction, this same traction needle 20 is inserted by penetrating the sleeve 23 of the lower finder and then penetrating either the upper or lower part of the tibia.

[0043] Furthermore, it should be emphasized that after the leg is first X-rayed from above and it is confirmed that the traction needle 20 does not penetrate the joint but remains below the joint surface, the traction needle 20 is moved from the upper finder to the lower finder. The upper and lower finders are positioned to overlap when viewed from above, and are aligned so that they overlap when the device is viewed from the side.

[0044] Once the position of the guide 21 is secured and precisely positioned, the traction needle 20 is inserted into the bone. This is usually done so that the same portion is exposed on both sides of the leg.

[0045] To drill into the bone, the traction needle 20 is attached to another hand drill (not shown) before drilling into the tibia through the sleeve 23, that is, once the guide 21 and thus the sleeve 23 have been set to the correct height relative to the tibia using the height adjustment unit 12. An overhead X-ray shows how close the needle is to the joint surface.

[0046] When the traction needle 20 is at position B, where it is embedded in the bone, the traction needle 20 is marked as 20B. Thus, position B represents the traction needle 20B at position B, which is embedded inside the bone. The order in which the needles 20 are positioned does not matter, but it is more common to position the traction needle in the upper part of the tibia first. Therefore, in this embodiment, it was assumed that the traction needle 20 would be embedded in the upper part of the tibia first.

[0047] The upper leg traction needles 20 are attached at both ends, for example, using winged screws 16' and clamps 14', to a first mounting arm 24 intended for them, with the legs at a small angle of about 10 degrees. The mounting arm 24 is then attached to a lateral support 6, which is fixed by a ring 27, and the fixed lateral support 6 passes through the ring 27.

[0048] The mounting arm 24 is attached to the lateral support 6 by a ring 27 and is rotatable forward and backward. When the screw 18 is loosened, the mounting arm 24 rotates together with the lateral support 6. Therefore, the mounting arm 24 can be rotated to a rearward position that does not interfere when the traction needle is attached to the patient.

[0049] The mounting arm 24 also moves slightly laterally along the lateral support 6 when the knurled head screw 32 is loose.

[0050] At the knee end, i.e., the end of the upper thigh, on the outer surface of the lateral support 6, there is a groove 7 that remains inside the device.

[0051] The purpose of groove 7 is to allow the mounting arm 24 to be locked with a tightening screw, such as a knurled head screw 32, in a position close enough to the skin for attaching the traction needle to the mounting arm 24. In other words, the mounting arm 24 is first positioned close to the skin and then locked with the knurled head screw 32 into the lateral groove 7 on the outer surface of the lateral support 6. Groove 7 prevents rotation of the mounting arm 24 because part of the tightening screw is at the bottom of groove 7. Without groove 7, tightening the mounting arm 24 against the rounded surface of the lateral support 6 could lead to the possibility of the arm 24 rotating.

[0052] Positioning of the second traction needle In this embodiment, positioning the second traction needle on the lower part of the tibia is performed using the same guide 21 that was used to position the first traction needle 20 on the upper part of the tibia.

[0053] Once the longitudinal position of the second traction needle is adjusted in the upper finder 11 in the same way as the first traction needle, the second traction needle is positioned by the connecting piece 31 and the sleeve 23 within it at the end of the lateral arm 13, which functions as the lower finder.

[0054] Inserting a second traction needle in the lower part of the tibia at the ankle is performed in the same manner as inserting the first traction needle 20 in the upper part of the tibia.

[0055] Since this figure is assumed to show the first traction needle 20 inserted into the upper part of the tibia, the second traction needle is not given its own designation. However, if the issue concerns the positioning of the second traction needle, Figure 1 is exactly the same, except that the first traction needle 20 is replaced by the second traction needle.

[0056] The traction needles for the lower legs are attached at both ends, for example, by wing screws 16 and clamps 14, to a second mounting arm 22 intended for them, which is attached to a moving lateral support 6', with the legs at a small angle of about 10 degrees.

[0057] The mounting arm 22 is attached to the lateral support 6' by a ring 27 and is capable of rotating forward and backward. The mounting arm 22 rotates together with the lateral support 6' when the screw 28 is loose. Therefore, when the traction needle is attached to the patient, the mounting arm 22 can be rotated to a rearward position that does not get in the way. Thus, the forward and backward movement of the mounting arm 22 can be adjusted with the screw 17, thereby allowing the lateral support 6' to rotate.

[0058] The mounting arm 22 also moves somewhat laterally along the lateral support 6' when the knurled head screw 32 is loose.

[0059] To position the traction needle, i.e., the traction needle for the lower leg, the mounting arm 22 is first positioned close to the skin, and then the knurled head screw 32 locks the lateral support 6', which moves along the lower support 3 within a groove on the outer surface of the lateral support 6' (similar to the one shown on the lateral support 6, though not shown in Figure 1), into place. At the ankle end, i.e., the lower leg end, the groove remains on the outside of the device.

[0060] Once the traction needle is positioned, rotate screw 17 to the forward position and lock it with the knurled head screw 28.

[0061] Several additional points of emphasis are disclosed below.

[0062] Generally speaking, if the screw 32 is loose, the towing needle 20 may already be attached to the mounting arm 22 or 24, and the mounting arm 22 or 24 may be moved laterally on the shaft 6 or 6'. The rods 6, 6' and the mounting arms 22, 24 must not move forward or backward under any circumstances after the towing needle 20 has been attached. If the screw 32 is too loose and the screw is no longer in the groove 7, the mounting arms 22, 24 may be able to rotate freely around the shaft 6, 6', but this must not happen.

[0063] The purpose of the long upper support 4 at the top of the device in the longitudinal direction is to stabilize the device. The upper support 4 can also be used to support the leg during the actual intramedullary nailing procedure, or when positioning the traction needle at the beginning of the procedure, for example, by using an X-ray drape. Support by an X-ray drape means positioning the drape so that both ends of the drape are attached to the upper support 4, for example, using drape forceps. One end of the drape is in one upper support 4 and the other end is in the other upper support. In this way, when positioning the traction needle, for example, the leg can be placed on one or more drapes, eliminating the need to support the leg.

[0064] The upper support 4 is typically positioned slightly higher than the traction needle mounting arm when the traction needle is in the forward position. This is to prevent the upper support 4 from obstructing X-ray imaging when imaging from the side relative to the leg.

[0065] The guide 21, used at the beginning of the procedure, is also attached to the upper support 4. The guide 21 slides unobstructedly along the upper support 4 from the knee to the ankle. The guide 21 is always attached to the outermost long upper support 4 relative to the leg being operated on. The traction needle is always positioned on the outermost upper support 4 because it is inserted into the tibia through the sleeve of the guide 21. The guide 21 has two functions: an upper finder 11 and a lower finder 13. The upper finder 11 is equipped with a lateral rod 30, the end of which is hollow, allowing the traction needle to be positioned at the end of the rod. The upper finder 11, with the help of the traction needle, uses an X-ray device to show how far the traction needle is from the joint surface, i.e., it is X-rayed from above relative to the leg. The lower finder 13 is used to observe the precise height of the traction needle using an X-ray device from a lateral direction relative to the leg. The lower finder 13 also includes a guide sleeve 23 through which the same traction needle initially used in the upper finder is driven into the bone. The lower finder also includes a height adjustment section 12, such as a vertical rod, which allows the height of the sleeve relative to the bone to be adjusted. In these two functions, the upper and lower finders are clearly aligned with each other when the entity is viewed from above.

[0066] The upper support 4 can be removed from the device when the intramedullary nail is positioned within the tibia, but this is not mandatory. The device can be configured so that the upper support 4 does not interfere when positioning the fixing screws for the nail.

[0067] In addition to stabilizing the device, the long lower support 3 also functions as a sliding rail for the guide carriage 8 or traction trolley at the ankle end. The carriage allows for the application of the appropriate amount of traction force to the leg to align the ends of the bones and allows for locking the guide carriage 8 to the lower support 3 so that it cannot move on its own.

[0068] The lower lateral supports 5' and 5'' are so-called fixed lateral supports that can be removed if necessary, but their purpose is to stabilize the device. A total of two mounting arms 24 for the traction needle are attached to the upper lateral support 6. There are also milled grooves at both ends of the lateral support 6 on the mounting arms 24, which means that the lateral support 6 can be rotated to a rearward position when the traction needle is positioned in the patient's body using the finder 13. Once the traction needle is positioned, the lateral support 6 is rotated to a forward position and locked in the forward position by a knurled head screw 18 to prevent the mounting arms 24 from shaking.

[0069] The guide carriage 8 (i.e., the traction carriage) moves unobstructedly along the lower support 3 from the ankle end to the knee end. The guide carriage 8 is equipped with bushings / sleeves (not reference numerals) for each of the lower support 3, through which the lower support 3 passes, and the sleeves have some kind of fixing screws (not reference numerals) through which the guide carriage 8 can be locked in a desired position on the lower support 3. At the top of the lower sleeves through which the lower support 3 passes, there is a separate mounting mechanism for the lateral support of the traction needle mounting arm, which is attached to the lower sleeve. The ankle traction needle mounting arm 24 functions in the same way as when it is mounted at the knee; that is, the mounting arm 24 can be locked in a forward position, and the lateral support 6 has a groove 7, so the traction needle mounting arm 24 can move laterally and be locked in a desired position in the groove 7 with a knurled head screw 32.

[0070] The upper support 4 is typically about 5-7 cm higher than the traction needle, which is inserted through the tibia and attached to mounting arms 22, 24 intended for the traction needle. Therefore, since the thickness of the human tibia is relatively constant in adult patients and the needle is usually inserted through the center of the bone, leg size is irrelevant. Thus, the upper support 4 never interferes with imaging. The ankle height is the same as the mounting arm 22.

[0071] The lateral support 6' is designed to move along the lower support 3 so that the leg can be tractioned and positioned on the lower support 3. For this purpose, the attachment arm 22 of the traction needle located below the tibia is on a sliding rail by the lateral support 6', and thus the end of the tibia can be aligned by pulling the lower attachment mechanism.

[0072] The leg is positioned by being pulled longitudinally and then repositioned laterally by aligning the ends of the bone at the fracture site, for example by using an X-ray bandage. The X-ray bandage is a lint-free fabric with small metal threads embedded in it. The purpose of the metal threads in the fabric is (when these fabrics are used in surgery to position fabric inside a person's body) to allow the fabric to be detected by X-ray imaging, as without this, it would be practically impossible to find the blood-soaked fabric. The length of the fabric is approximately 40 cm, and when folded, the width is approximately 30 cm. The fabric can also be used to assist in the attachment of the traction needle by placing the fabric laterally on the upper support 4 so that the leg is supported on the fabric. This eliminates the need to support the leg when positioning the needle and makes it easier to hold the leg in place.

[0073] The holes in the ring 27 of the lateral support 6' have screw threads, and when the knurled head screw 32 is tightened into the bottom of the groove, the knurled head screw 32 can hold the mounting arms 22 and 24 in place, and when the knurled head screw 32 is loosened, the mounting arms 22 and 24 can be moved again simultaneously. Also, because the screw is in the groove and not in contact with a rounded surface, the weight of the legs prevents the mounting arms 22 and 24 from rotating downward. Similarly, the ring 27 in the lateral support 6 is equipped with a knurled head screw, not shown in Figure 1, which is used for tightening in a similar manner.

[0074] Once the traction needle 20 is positioned in the designated location, the actual intramedullary nail fixation is performed.

[0075] Next, the surgeon makes an incision above the patella and inserts the instruments used for the incision into the medial side of the tibia from below the patella. First, a tissue protector is placed below the patella. This tissue protector prevents the instruments from damaging tissue or other important areas unrelated to the surgery itself. All instruments necessary for this procedure, except for the intramedullary nail, are inserted into the tibia through the tissue protector.

[0076] Next, using a slightly larger drill bit, drill an entry point into the bone to a depth of approximately 4 cm along its longitudinal direction.

[0077] Next, a guide wire is inserted into the bone, reaching down to the ankle. The guide wire is approximately 2mm to 3mm in diameter. The guide wire is used because the drill used to perforate the bone marrow is hollow and runs inside the drill bit, preventing the bit from penetrating the tissue at the fracture site and causing tissue damage.

[0078] After this, the bone marrow is gradually "reamed" from the inside of the bone by changing the drill bit to a 1.5 mm larger drill bit after each perforation until there is enough space to insert the intramedullary nail.

[0079] Next, the intramedullary nail is inserted into the bone with the help of a guidewire.

[0080] Once the intramedullary nail is inside the bone, the guidewire is removed, and the upper horizontal support 4 is optionally removed from the side of the device.

[0081] Here, the intramedullary nail is secured in the patient's body with screws. Next, the upper support 4 is optionally removed, and then the legs can be detached from the traction needle attachment arms 22, 24, the needle is cut from one side closer to the skin, and pulled out of the patient with flat pliers.

[0082] After these procedures, the incision is closed and covered with a wound dressing.

Claims

1. An intramedullary nailing device for the tibia, The framework consists of vertical supports (2), longitudinal horizontal supports (3, 4), and transverse horizontal supports (5, 5', 5'', 6, 6'), A traction needle (20) is passed through the tibia, A guide slidably coupled to the longitudinal horizontal support (4) of the apparatus and The guide (21) is provided with, A first finder (11) for adjusting the position of the traction needle (20) relative to the articular surface of the upper part of the tibia in a direction parallel to the longitudinal horizontal support (3, 4) and in a direction parallel to the transverse horizontal support (5, 5', 5'', 6, 6'), The position of the traction needle (20) is adjusted in a vertical direction parallel to the vertical support (2), and a second finder (13) is provided for passing the traction needle (20) through the tibia in the lateral direction of the tibia. Equipped with, The apparatus is characterized in that the mounting arms (22, 24) are configured to be attached to the frame and to the end of the traction needle (20) which is passed laterally through the tibia using the guide (21).

2. The apparatus according to claim 1, wherein the mounting arms (22, 24) include a first mounting arm (22) for the traction needle (20) below the tibia, the first mounting arm (22) being attached to a transverse horizontal support (6') slidably mounted between some of the longitudinal horizontal supports in the frame.

3. The apparatus according to claim 2, wherein the lateral horizontal support (6'), which is slidably mounted between the longitudinal horizontal support bodies, slides along the longitudinal horizontal support bodies by means of a guide carriage (8).

4. The apparatus according to claim 3, wherein the longitudinal horizontal support consists of an upper support (4) and a lower support (3), and the lower support (3) functions as a sliding rail for the guide carriage (8).

5. The apparatus according to claim 1, wherein the mounting arms (22, 24) include a second mounting arm (24) for the traction needle (20) above the tibia, the second mounting arm (24) being mounted in the frame to a lateral horizontal support (6) which is fixed between two vertical supports (2).

6. The apparatus according to claim 2, wherein the mounting arms (22, 24) include a second mounting arm (24) for the traction needle (20) above the tibia, the second mounting arm (24) being mounted in the frame to a lateral horizontal support (6) which is fixed between two vertical supports (2).

7. The apparatus according to claim 3, wherein the mounting arms (22, 24) include a second mounting arm (24) for the traction needle (20) above the tibia, the second mounting arm (24) being mounted in the frame to a lateral horizontal support (6) which is fixed between two vertical supports (2).

8. The apparatus according to claim 4, wherein the mounting arms (22, 24) include a second mounting arm (24) for the traction needle (20) above the tibia, the second mounting arm (24) being mounted in the frame to a lateral horizontal support (6) which is fixed between two vertical supports (2).

9. The apparatus according to claim 6, wherein the lateral horizontal support (6', 6) is configured to rotate forward and backward, meaning that the first mounting arm (22) and the second mounting arm (24) attached to the lateral horizontal support (6', 6) can rotate to forward and backward positions.

10. The apparatus according to claim 7, wherein the lateral horizontal support (6', 6) is configured to rotate forward and backward, meaning that the first mounting arm (22) and the second mounting arm (24) attached to the lateral horizontal support (6', 6) can rotate to forward and backward positions.

11. The apparatus according to claim 8, wherein the lateral horizontal support (6', 6) is configured to rotate forward and backward, meaning that the first mounting arm (22) and the second mounting arm (24) attached to the lateral horizontal support (6', 6) can rotate to forward and backward positions.

12. The apparatus according to claim 1, wherein the guide (21) comprises a first finder (11) to which a first attachment means (25) is attached for passing the traction needle through the lower and upper parts of the tibia, and a second finder (13) to which a second attachment means (10) is attached.

13. The apparatus according to claim 12, wherein a vertical height adjustment unit (12) is connected to the guide (21), the vertical height adjustment unit (12) is attached at its upper part to the first mounting means (25) or to a separate mounting element (9) within the guide (21), and at its lower part to the second mounting means (10), and the first finder (11) and the second finder (13) are located within the same guide (21) and are adjustable to different heights.

14. The apparatus according to claim 6, wherein the mounting arms (22, 24) are attached to the lateral horizontal support (6' and 6, respectively) by rings (27, 27') surrounding the first mounting arm (22) and the second mounting arm (24), and the rings (27, 27') are provided with screw holes through which screws (32) can be tightened to the bottom of the grooves in order to maintain the first mounting arm (22) and the second mounting arm (24) in a predetermined position.

Images