DE202015008957U1 - Locking nail for tarsal joint stiffening in charcotathropathy - Google Patents

Abstract

A medical nail (1) for treating a charcteroid artery with a longitudinal axis, comprising: a first bore (2) having an internal thread, the first bore (2) being disposed perpendicular to the longitudinal axis; a second bore (3) having an internal thread; second bore (3) is formed obliquely to the longitudinal axis, a third bore (4) at a first end of the nail (1), wherein the third bore (4) is formed in the direction of the longitudinal axis.

Description

FIELD OF THE INVENTION

The present invention relates to a technology which may fall under the following title: Locking nail for tarsal joint stiffening in Charcotarthropathie.

BACKGROUND OF THE INVENTION

A technical field of the invention can be summarized as follows. The invention is in the field of medical technology and represents a new way to treat tarsal joints in the diabetic Charcotarthropathie, which can be made minimally invasive and stable.

Charcotarthropathy of the tarsus as well as destructive tarsal arthrosis requires surgical stabilization of the tarsal joints as well as the rebuilding of the arch of the foot. As a result, the occurrence of severe pressure ulcers in the area of the sole of the foot can be prevented and normal walking can be made possible again.

In particular, the following prior art can be considered as being within the scope of the invention: Operational stabilization has hitherto been accomplished by the use of angle stable screw plate systems or by the use of mid-foot fusion bold provided by foot-mounted fixator systems be kept in the desired position.

SUMMARY OF THE INVENTION

The occurrence of pressure ulcers frequently causes infections. This can make amputations necessary. The disease of charcotarthropathy occurs mainly in people with advanced diabetes mellitus and results in the context of existing polyneuropathy to a break in the arch of the foot. Stabilization of the ankles is essential in these patients to restore autonomous mobility. The stabilization of the tarsal joints in the case of the charcotarthropathy requires a very stable osteosynthesis, since the affected patients often can not perform a relief of the leg due to the sensory disorders of the foot in the context of the charcotarthropathy and the bone healing is usually slower than in healthy patients.

However, the cited prior art can lead to disadvantages. Operational stabilization has hitherto been accomplished by the use of angle stable screw plate systems which require a large operative access path and poor stability with frequent screw breaks. Alternatively, long compression bolts (mid-foot fusion bold) are used. However, these do not have sufficient rotational stability and therefore frequently lead to implant failure. Even externally mounted fixator systems do not provide sufficient stability and are susceptible to complications.

It can therefore be considered as an object to mitigate or completely avoid the disadvantages of the prior art.

To solve this problem, the following is proposed, which can be considered as the subject of the invention.

As a first embodiment of the invention, there is provided a medical nail for treating charcteroid arthropathy having a longitudinal axis, comprising: a first bore having an internal thread, the first bore being perpendicular to the longitudinal axis, a second bore having an internal thread, the second bore is formed obliquely to the longitudinal axis, a third bore at a first end of the nail, wherein the third bore is formed in the direction of the longitudinal axis. The embodiment may be supplemented by a fourth hole at a second end of the nail, wherein the fourth hole is formed in the direction of the longitudinal axis.

It is understood that the first bore in particular a type of bore is meant that differs from other types of holes, such as position and orientation. This is of course also for the mentioned second, third and fourth hole. Furthermore, the term "askew" generally means "neither parallel to the plumb line of the longitudinal axis, nor to the horizontal of the longitudinal axis, or to a relevant line or plane neither parallel nor perpendicular".

The nail may be referred to as a locking nail for tarsal joint stiffening in charcotarthropathy.

As a result of the abovementioned solution, there are several advantages over the prior art, which will be explained in more detail below. The advantages achieved by the invention are, in particular, that the technique of locking nailing with the wire guided insertion, a soft tissue gentle insertion (minimally invasive technique) combined with a high biomechanical rotational stability. Thus, in the future, patients can be treated more stably with less risk of complications and thus the quality of life of the patients with the Charcotarthropathy can be improved and amputations avoided.

Principle of locking nail nailing with high biomechanical stability by an intramedullary force carrier, which is successfully used in accident surgery since 1940 by the invention of the femoral nailing by Küntscher, can now also be used in the stabilization of the tarsal root. Possibilities of locking allow a great rotational stability as well as a compression of the arthrodeses. The stability in combination with the anti-rotation device makes it possible to dispense with additional stabilization of the lateral column of the foot. By introducing the nail through minimally invasive approaches, the soft tissue trauma is significantly reduced, because only small additional incisions need to be made for the cartilage of the joints. The previously feared in the Charcotarthropathie and frequently occurring wound healing disorders and infections are avoided. Due to the minimally invasive procedure, the blood supply to the bones is little affected and thus a higher bone healing rate is achieved. The solid tarsal locking nail provides a minimally invasive approach that is essential for soft tissue in diabetic subjects, with maximum biomechanical stability and rotational stability. An insertion aid for the target wire allows a precise insertion of the nail without loss of repositioning and at the same time allows the use of a solid nail without loss of stability.

In particular, the abovementioned disadvantages can be avoided by means of an embodiment of the invention: The above-mentioned problems of the large operational access paths, the lack of stability and the lack of rotational stability are solved by the features according to the invention. Also, the introducer allows accurate targeting of the nail without weakening the stability of the implant.

The subject of the invention may be further developed by considerations familiar to one skilled in the art. Not obvious are the following developments and aspects of the invention:
In another embodiment of the invention, a nail is provided, the nail being titanium.

According to another embodiment of the present invention, a nail is provided, wherein the nail 2 . 3 . 4 or any number of first holes, wherein the first holes are suitable for receiving distal locking screws.

According to an exemplary embodiment of the invention, a nail is provided, wherein the nail 2 . 3 . 4 or any number of second bores, wherein the second bores are suitable for receiving proximal locking screws.

In a further embodiment of the invention, a nail is provided, wherein the third or fourth bore is provided for receiving a threaded wire.

The insertion aid for the target wire allows a precise insertion of the nail without loss of repositioning and at the same time allows the use of a solid nail without loss of stability.

It should be noted at this point that the invention proposed for achieving the object immediately and directly yields other categories of objects according to the invention. In particular, the invention relates to corresponding methods and apparatus, applications, in particular software for executing the method and memory means on which this software can be stored, and finally, but not limited to, hardware on which the aforementioned software can be executed.

The advantages achieved by the invention are in particular that the technique of locking nailing with the wire guided insertion, a soft tissue gentle insertion (minimally invasive technique) combined with a high biomechanical rotational stability. Thus, in the future, patients with a lower risk of complications can be treated more stably and thus the quality of life of the patients with the charcterotrophy can be improved and amputations can be largely avoided.

The principle of locking nail nailing with high biomechanical stability by an intramedullary force carrier, which has been successfully used in accident surgery since 1940 by the invention of the thigh nailing by Küntscher, can now also be used in the stabilization of the tarsal root. The possibilities of locking allow a great rotational stability as well as a compression of the arthrodeses. The stability in combination with the anti-rotation device makes it possible to dispense with additional stabilization of the lateral column of the foot. The introduction of the nail via minimally invasive approaches will significantly reduce soft tissue trauma, because only small additional incisions need to be made for the cartilage of the joints. The previously feared in charcotarthropathy and frequently occurring wound healing disorders and infections are avoided. By the minimally invasive Procedure, the blood supply to the bone is little affected and thus achieved a higher bone healing rate.

The insertion aid for the target wire allows a precise insertion of the nail without loss of repositioning and at the same time allows the use of a solid nail without loss of stability.

Of course, the individual features can also be combined with each other, which can also be advantageous effects that go beyond the sum of the individual effects.

BRIEF DESCRIPTION OF THE DRAWINGS

Further details and advantages will become apparent from the embodiments illustrated in the drawings. Show it:

1 the medical nail according to the invention 1 in a plan view,

2 the medical nail 1 in a front view and

3 the medical nail 1 in a side view.

DETAILED DESCRIPTION OF THE DRAWINGS

1 shows the nail 1 as a solid 7 mm titanium nail. The nail 1 has locking holes 2 on, perpendicular to the longitudinal axis of the nail 1 are provided for receiving distal locking screws. The locking screws are transferred to the metatarsal via a targeting bar 1 brought in. There are also locking holes 3 present with the longitudinal axis of the nail 1 have a 60 ° angle and are provided for receiving proximal locking screws. The proximal locking screws are inserted into the talus via a targeting bar. It is a threaded wire 6 with a diameter of 2.5 mm to be used as an insertion aid without reduction loss for screwing on the target bracket for locking screws 2 . 3 to serve.

The invention includes a solid nail 1 in particular titanium, which has a diameter of 6-8 mm and a length of 10-16 cm. The diameter and length should be chosen according to the dimensions of the patient's bone and medullary canal. At the far end of the nail 1 For example, two are to the longitudinal axis of the nail 1 vertical holes / perforations 2 placed in the 3 mm diameter locking screws in the metatarsal 1 can be introduced. At the front end of the nail 1 are another two holes / holes 3 at an angle of 60 ° to the nail longitudinal axis, can be introduced into the 3 mm diameter locking screws in the talus. At the front end of the nail 1 is a 2.5 mm thick thread 4 attached, in a matching 2.5 mm thread 6 can be screwed. The thread wire 6 Can be used as an insertion aid for the arrangement of the nail 1 to be used in the foot. At the far end of the nail 1 is a thread 5 attached, in which a target bracket for the placement of the locking screws can be attached.

In a stiffening operation of the tarsal joint in the charcotarthropathy after cartilage removal of the TMT 1 joint, the NC joints and the TN joint via a dorsal incision above the great toe joint and the presentation of the metatarsal 1 Head of the 2.5 mm thick target wire is centrally introduced into the metatarsal 1 shaft, the OS cuneiform medial, the navicular and the talus and discharged percutaneously dorsally laterally adjacent to the Achilles tendon. Then drill the bones with a cannulated drill over the inserted wire to the strength of the intended nail 1 , After measuring the nail length of the nail 1 with its tip thread on the 2.5mm wire 6 screwed on and then hammered with careful hammer blows in the previously drilled bone. He follows the enclosed 2.5 mm wire 6 with which he is connected via the thread. The wire 6 is thus expelled dorsally from the talus when hammering the nail. After correct position of the nail 1 in the medullary canal of the metatarsal 1 and in the talus is the 2.5 mm wire 6 turned out of the thread on the nail tip and removed.

About the end of the nail attached to the nail piercing of the locking holes with a 3 mm drill is done via stab incisions on the skin. After measuring the screw length, the locking screws of thickness 3 mm can be placed in the two 60 ° at the end of the nail to the longitudinal axis of the nail 1 inclined locking holes are screwed in front of or behind the distal fibula. Then you can nail with a hammer 1 slightly deflected distally to achieve compression of the affected tarsal joints. Then, via the aiming bar via stab incisions, the boring of the nail base located at the Verrieglungslöcher, which run perpendicular to the nail axis. After the screw length has been measured, two locking screws are inserted over the applied insertion handle into the metatarsal 1 , Finally, the insertion handle is removed from the nail and the suture of the skin.

The insertion aid for the target wire allows accurate insertion of the nail 1 without loss of reduction while allowing the use of a solid nail 1 without loss of stability.

It should be noted that the term "comprising" does not exclude other elements or method steps, just as the term "a" and "an" does not exclude multiple elements and steps.

It is understood that the drawings are executed mainly schematically and are intended in particular to assist understanding of one or more embodiments. If numbers or dimensions are shown, these are not initially restrictive, but explanatory. However, since these details represent an embodiment as particularly advantageous, they can still be used at a later date as determining the scope of protection, even without being based on a further verbatim or other mention in the rest of the description part.

The reference numbers used are for convenience only and are not to be considered as limiting.

It is further understood that the scope of the invention is not limited to the literal language of the claims, but also includes equivalent embodiments.

LIST OF REFERENCE NUMBERS

1

nail

2

distal locking holes

3

proximal locking holes

4

Thread for threaded wire

5

Thread for aiming bar

6

threaded wire

Claims (6)

Medical Nail ( 1 ) for the treatment of charcteroid arthropathy having a longitudinal axis, comprising: a first bore ( 2 ) with an internal thread, wherein the first bore ( 2 ) is arranged perpendicular to the longitudinal axis, a second bore ( 3 ) with an internal thread, wherein the second bore ( 3 ) is formed obliquely to the longitudinal axis, a third bore ( 4 ) at a first end of the nail ( 1 ), the third hole ( 4 ) is formed in the direction of the longitudinal axis. Nail ( 1 ) according to claim 1, characterized in that the nail has a fourth bore ( 5 ) at a second end of the nail ( 1 ), wherein the fourth bore ( 5 ) is formed in the direction of the longitudinal axis. Nail ( 1 ) according to claim 1 or 2, characterized in that the nail ( 1 ) consists of titanium. Nail ( 1 ) according to one of the preceding claims, characterized in that the nail ( 1 ) two, three, four or any number of first holes ( 2 ), wherein the first bores ( 2 ) are suitable for receiving distal locking screws. Nail ( 1 ) according to one of the preceding claims, characterized in that the nail ( 1 ) two, three, four or any number of second holes ( 3 ), wherein the second bores ( 3 ) are suitable for receiving proximal locking screws. Nail ( 1 ) according to one of the preceding claims, characterized in that the third or fourth bore ( 4 . 5 ) for receiving a threaded wire ( 6 ) is provided.

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