WO2021198031A1

WO2021198031A1 - Flexibly adaptable orthopedic aid for limbs containing joints

Info

Publication number: WO2021198031A1
Application number: PCT/EP2021/057803
Authority: WO
Inventors: Felix Carstens
Original assignee: Carstens Orthopädie- Und Medizintechnik Gmbh
Priority date: 2020-03-31
Filing date: 2021-03-25
Publication date: 2021-10-07
Also published as: DE102020108959A1

Abstract

The invention relates to a frame orthosis (1) for guiding and stabilizing an anatomical joint, in particular a knee joint, comprising a self-supporting frame structure (2). The frame orthosis (1) has two lateral rails (3, 4) for collaterally guiding and stabilizing the joint and at least one clamp (6, 7) which connects the lateral rails (3, 4) and at least partly surrounds the circumference of the limb during use. The clamp (6, 7) has a continuously variable length and is designed to be continuously elastically flexible. The clamp (6, 7) contains a first and a second clamp element (28, 29), each of which is rigidly connected to one of the lateral rails (3, 4) at one end and which run towards each other and overlap, wherein the length of the overlap (32) can be continuously adjusted by moving the clamp elements (28, 29) towards each other or away from each other in the longitudinal direction thereof. Each clamp element (28, 29) has one or more thin plate-shaped lamellae (33, 34) which are flat in the unloaded state and which are designed to be flexurally elastic and longitudinally nonelastic. A tutor-type joint rail (61) with a textile support (62) and lateral rails (64, 66) made of spring elastic lamellae (77) is likewise disclosed for limiting a bending or stretching movement of a joint.

Description

Flexibly adaptable orthopedic aids for limbs containing joints

The present invention relates to an orthopedic aid for guiding, immobilizing and / or stabilizing an anatomical, in particular human, joint. In particular, the present invention relates to a frame joint orthosis and a tutor joint splint which allow adaptation to the respective individual shape and / or size relationships of a patient's limb that has a joint.

Orthoses are applied as orthopedic aids on the outside of the body, in particular the limbs of a human or animal patient, to relieve joints, muscles or bones, to stabilize or align and to supplement their form and function. There are orthoses for different joints, e.g. knee, elbow, ankle orthoses, etc., in different shapes and sizes, made of different materials and for different purposes.

For example, elastic joint bandages in the form of closed or closable hoses made of an elastic carrier material, also with cushioning or corrective Profileinla conditions, are widely used, which are pulled over the respective joint, e.g. like a stocking over a knee, in order to support it and to protect against incorrect movements. Such elastic bandages are mostly used in cases of low instability of a joint or inflammation, in the case of slight postoperative muscle atrophy and for muscle building. The bandage can have a desired compression effect on the limb and the joint Achieve and use the profile inserts to provide an additional massage effect when the joint moves, which can promote the healing process. Such an elastic knee joint bandage is described, for example, in DE 4311 500 CI.

In the case of greater instabilities of a joint, ligament, Achilles tendon or meniscus injuries, severe osteoarthritis and postoperative therapies, frame orthoses are often used that have a self-stabilizing rigid frame with side rails, in particular joint rails. The splints can prevent, limit and / or guide the flexion and extension of a joint and the rotational movement of limb sections connected via the joint. Such frame orthoses are placed over the respective joint and are usually secured around this with Velcro fasteners and straps. They have a stabilizing, relieving or guiding function and generally do not allow any compression or massage effect. Such an effect would also be advantageous in the case of frame orthoses.

To ensure that frame orthoses sit and function correctly and do not slip, they must be specially adapted to the respective conditions of use. For example, the size of the orthosis must match the individual size of the patient, in particular the limb and the joint. The orthosis must fit tightly and cut gaps between the orthosis and the limbs and minimize the joint. Excessive pressure, which could cause pain, limb swelling, or injury to the patient, must be avoided. For this reason, frame orthoses are generally created specifically for the respective patient or pre-assembled orthoses are adapted.

It is also an adaptation to a possibly changing changing anatomy of a patient is required in the course of therapy or treatment. For example, the thigh or arm circumference can decrease as a result of muscle atrophy or simply as a result of the reduction in swelling, and the orthosis could lose its stable hold on the limb. Conversely, swelling caused by injuries or muscle build-up can increase the circumference of the limbs. An easy and quick adjustment facility would always be desirable in order to adapt the orthosis to the changing anatomical conditions.

From EP 0393 081 B1 a frame orthosis for a human knee is known, which has two joints arranged on the sides of the knee, arms protruding from the joints, which converge in a central tab, from the outside, interchangeable longitudinal rails and adjustment means which allow direct adaptation of the orthosis to a patient's leg. The adjustment means include on the hinge arms, tabs and longitudinal rails formed rows of holes and associated screw means with which a different length ge of the overlap of the elements can be set and fixed so as to different distances between the elements to the joints of the orthosis and different lengths of the orthosis to obtain. For this, however, a relatively large number of elements, some of which have a complicated design, are required, and the adjustment process, in which the orthosis is placed on the patient's leg and the adjustment means must be individually aligned and fixed one after the other, can be tedious and lengthy. In addition, the setting can only be made in discrete steps.

An orthosis for a knee is known from DE 102009 038 517 A1, which is formed from a modular system from which a knee support, a knee guide orthosis with lateral joint rails with or without extension and / or flexion limitation or a frame orthosis with or without extension tension and / or flexion limitation can be compiled. One embodiment of the frame orthosis has an upper leg shell and a lower leg shell, which are connected to one another and fastened to one another on the left and right via a hinge rail. In order to adapt the frame orthosis to a patient's leg, the thigh shell is made in two parts, with two circular segment-shaped elements that overlap and are designed to be adjustable by means of an adjusting element. The adjusting element comprises an adjusting band which is fastened to a part of the thigh shell and has barb-like locking elements which interact positively with an adjusting knob on the second part of the thigh shell. The adjustment knob can be spring-loaded. With the adjustment element, it is possible to gradually adjust the degree of overlap and thus the arc length that the two shell elements together form. As a result, a certain adjustment of the arc length of the thigh shell to the shape and size of the patient's knee is possible. Since the circular segment-shaped shell elements are preformed and relatively rigid, an optimal adaptation to the anatomy of the thigh with different lengths and curvature diameters is not possible. In addition, by adjusting the arc length of the shell elements, the joint geometry of the rail joints can also change in such a way that the axes of rotation of the two rail joints lose their congruence and no longer coincide, but are at an angle to one another. However, a congruence of the splint joints is essential for the orthosis to function properly in order to correctly guide flexion and extension movements of the knee joint.

For postoperative care after surgical interventions on joints, especially knee joints, e.g. after anterior / posterior cruciate ligament surgery, meniscus surgery, knee arthroplasty so-called "tutors", which are also referred to as post-surgical splints, are often used. These serve to immobilize the limb with the joint, usually in a stretched or slightly bent position. The tutors essentially consist Made of a textile carrier that is wrapped around a limb with the joint and is adjustable so that it can be adapted to the limb in a circular manner.

The carrier contains a splint to the right and left of the anatomical joint (medial and lateral), which are used to limit or block the range of motion of the anatomical joint. The rails of the tutors can optionally be provided with or without a swivel or swivel joint, which allows or specifies a limited flexion of the anatomical joint.

When adapting such tutors to a limb, in particular a patient's leg or knee, it is important that the anatomical backdrop of the leg is taken into account in the longitudinal direction. Inside (medial), for example, a natural knee joint, viewed from the front or back, is essentially convex along the leg, while outside (laterally) it has a more concave shape. In general, the outer contour along a leg has several changes of curvature on both the lateral and the medial side in the knee area, which the tutors' splints should accommodate. When adapting conventional splints from tutors for knee joints, the splints must be adapted to the scenes of the leg in order to obtain a good stabilizing effect along the knee joint and to avoid pain from pressure points. This adjustment is made, for example, by an orthopedic technician who bends the tutors' rails in several steps according to the outer contour of the leg in several places, with the tutor having to be tried on the respective knee of the patient after each step. This Passing process can be tedious and lengthy.

Based on this, it is an object of the present invention to eliminate the above-mentioned inadequacies of conventional orthopedic aids for anatomical joints and to create such orthopedic aids that can be easily and flexibly adapted to the respective limb and the respective joint.

In particular, it is an object of the present invention to create a frame joint orthosis that allows good adaptation to the respective individual size relationships of the patient and adjustment options with simple, inexpensive means and with little effort. Before geous enough, the frame joint orthosis should also enable a desired compression on the limb similar to an elastic joint bandage.

Another object of the invention is to create a tutor joint splint that allows good, easy and quick adaptation to the respective individual outer contour of a patient's limb having a joint and adjustment possibilities with simple, inexpensive means and with little effort.

These objects are achieved by the frame joint orthosis for guiding and stabilizing an anatomical joint with the features of claim 1 and a tutor joint splint for limiting a range of motion of an anatomical joint according to claim 18.

The frame joint orthosis according to the invention, which is intended, for example, for a knee, elbow, hip or ankle joint, in particular of a human patient, has a self-supporting one Frame construction with two side rails and at least one clamp connecting the side rails. The side rails are provided for arrangement along a limb having the anatomical joint for collateral guidance and stabilization of the joint. The at least one clamp is provided to enclose the limb in sections around the catch side. The at least one clamp is continuously adjustable in length and continuously elastically flexible. The at least one clamp has a first and a second resilient clamp element, each of which is connected to one of the lateral rails in a rigid manner at one end. The clamp elements run towards one another and overlap one another, the length of the overlap being continuously adjustable relative to one another by shifting the clamp elements in the longitudinal direction thereof. Each clamp element has one or more thin, plate-shaped, spring leaf-like, flat lamellae in the unloaded state, which are flexurally elastic and longitudinally inelastic, the flexural elasticity of the lamellae a flexibility of the Schel lenelemente in the circumferential direction around a longitudinal axis of the limb to stepless, continuous Allows adaptation to the cross-sectional shape of the limb.

The invention is based on the knowledge that it is possible to use flexible, leaf-spring-like elements or federelasti cal lamellae, which have the shape of flat plates in the unloaded state, for the otherwise rigid clamps that connect the longitudinal rails of a frame orthosis as hard frame cross elements , but allow strong elastic deformation of the lamellas and the resulting clamps when a force is applied. When the force is relieved, the slats spring back into their flat plate shape. The lamellas lying one above the other with their flat sides can be moved against one another by the resulting length of the adjust at least two communicating leaf spring elements or lamellae formed clip elements. Advantageously, the length of the clamp as well as the curvature or the bending radius of the clamp elements are infinitely variable and independently adjustable and, if desired, can be fixed depending on the direction, so that the clamp optimally adapts to the respective anatomical conditions, e.g. the average limb thickness and more or less locally formed muscle parts, adapt and cling to the surface of the limb around its circumference. The flexible lamellas can even adapt well to a cross-sectional shape of the limbs deviating from a circular shape. The high flexibility of the lamellas also makes it possible to set a desired uniform compression pressure along the peripheral portion of the limb. In this way, in addition to the effects of a frame orthosis, at least some of the effects of an elastic bandage can also be achieved. Locally excessive pressures and pressure points that could cause pain can be avoided.

The flexible lamellas can advantageously consist of Me tall, plastic, a metal-plastic composite or a fiber-reinforced plastic. Lamellas made of spring band steel or made of glass or carbon fiber reinforced plastic are particularly preferred. They provide a basis for a particularly light construction of the clamp elements with high wearing comfort and a very high elastic deformability.

The deformability is also favored by the small thickness of the first and second clamp elements. The thickness of the clamp elements, measured perpendicular to the plate surface of the slats, is preferably smaller than the thickness of the side rails. In particular, the thickness of each lamella can be less than 1 mm, preferably less than 0.5 mm. In embodiments, the lamella thickness can even be a maximum of 0.3 mm.

In advantageous embodiments, the lamellae have such a high flexural elasticity that they cause an elastic deformation of the first and second clamp elements perpendicular to their longitudinal direction or around the longitudinal axis of a limb, from a substantially flat shape to at least one substantially semicircular shape allows, in which the non-overlapping ends of the Schellenelemen te are aligned essentially parallel. This can also be possible with maximum overlap of the slats with the highest stiffness of the clamp elements. With a smaller overlap length of the lamellas, the clamp element ends connected to the side rails can in some embodiments even be brought together up to 300 ° of a circumference or more.

The flexural elasticity of the lamellas can also allow elastic twisting around the longitudinal axis of the clamp elements up to a few degrees, for example up to 5 ° or more. As a result of the elastic torsion, the clamp elements can be better adapted to a given anatomy and irregularities in the circumferential section encompassed by the clamp elements.

The high flexural elasticity and easy twisting ability of the slats is also favored by the narrow width of the slats. The width (in use the height) of the lamellas, measured perpendicular to their length and thickness direction, can essentially correspond to the width of the side rails.

It can be smaller than at least the maximum width of the lateral rails. As a result, the clamp elements do not wear a lot so that they increase the comfort for the patient. They also allow the frame orthosis to be integrated into elastic joint supports.

In some embodiments, at least one of the first and the second clip element or both clip elements can each have two or more lamellae. The lamellas of the first clamp element and those of the second clamp element are then preferably alternately stacked on top of one another. Due to the higher number of lamellas, the stability and rigidity of the clamp can be designed appropriately for a given elastic deformability. A further fixation can, if necessary, be achieved, for example, by a sleeve that surrounds the lamellar arrangement and is slightly compressed, for example a Velcro strip.

For preferred applications, the frame orthosis preferably has two continuously adjustable and continuously elastic bendable clamps of any type mentioned above, each of which connects the identically aligned, opposite ends of the side rails with each other. In this way, a stable, self-supporting frame that is essentially rectangular in plan view is formed. In use, the two clamps can enclose the limb sections on both sides of a joint, e.g. the thigh and lower leg on both sides of a knee joint, and form a stable frame thanks to the rigid connection with the joint splints, whereby due to the flexibility of the arc lengths the Clamps a compressive effect of any existing elastic textile base element is not impaired.

The frame orthotic may further include a shell that incorporates the overlapping arrangement of the first and second Clamp element encloses the respective clamp and prevents the lamellae from giving way in the direction of thickness and width. The cover can be formed for example by a Velcro strap, a hose or by soft or stiff loop elements.

In preferred embodiments, the sheath has an outer tube that is pulled over the arrangement of lamellae. In advantageous developments, the tube can be a heat-shrink tube that is pulled over the lamella package when the frame orthosis is manufactured and is shrunk on by adding heat, e.g. hot air, in such a way that it holds the lamella package together and guides it in a stable manner in the event of a longitudinal displacement. Instead of a shrink tube, it is also possible to use a non-shrinkable tube with a suitable diameter or with a suitable width when lying flat. In any case, the result is a particularly simple, cost-saving and efficient implementation. No mechanical fixing elements such as screws, rivets or the like are required.

Preferably, the sheath can further comprise a further largely cut-resistant tube which surrounds the lamellae and is inserted between the lamellae and the outer tube, e.g. the heat-shrink tube. The additional tube offers the outer tube protection from the sharp edges of the thin lamellae and against abrasion, so that possible damage to the outer tube and injury to the patient can be excluded. Braided, laid or woven hoses made of a cut-resistant material, in particular made of Kevlar fiber, or fiber-reinforced hoses can provide effective protection against cuts.

If it is desired that the lamellas of the clamp element elements remain mutually displaceable in the longitudinal direction, for example in order not to hinder additional compression, then a hose made of a smooth material with a low coefficient of friction directly on the lamellas can also serve to keep the friction between the lamellar elements low - and thereby to enable a relative displacement - if an above-mentioned shrink tube is used.

The frame orthosis can also have a fixing device for fixing the first and second clamp elements relative to one another after setting the desired overlap length. The fixing device is preferably set up to define a maximum length of the resulting clamp, i.e. to prevent a relative displacement of the first and second clamp elements away from one another, but to allow a displacement of the clamp elements towards one another, i.e. in the direction of a shorter arc length. This also enables automatic readjustment within a certain length range of the clamp.

Suitable fixing means are preferably set up for non-positive or frictional fixing of the set length of the clamp. For example, an inelastic Velcro strip can be used, which is arranged and effective to limit the set distance between the ends of the side rail connected via the clamp. Although this distance can be reduced ver, an enlargement of the same is prevented by the fixing means.

A wide variety of other fixatives are possible. For example, a fixation can be done with means in the manner of Kabelbin countries or Velcro strips that are placed around the Schel lenelemente and tightened. In some embodiments, the frame orthosis can furthermore have means which are set up to preload the first and second clamp elements against one another in the sense of reducing the length of the clamp. For example, elastic belts or straps can be provided which engage the connecting ends of the slats with the side rails and pull them towards one another. It is also possible to use other pretensioning means, which can be based on springs, for example.

In addition, different embodiments of the frame joint orthosis are possible. The side rails preferably have swivel or swivel joints that allow the rails to rotate or swivel in accordance with the natural flexion and extension movement of the joint, e.g., a human knee.

Inelastic tension elements, in particular fastening or Velcro straps, can also be provided in order to secure the frame orthosis by means of a so-called 4-point attachment to the limb. For example, two mounting levels of the frame orthosis for the thigh and two mounting levels for the lower leg can be provided in a knee orthosis. The connection created in this way, which is known to the person skilled in the art as a fastening with so-called 4-point effect, can effectively prevent incorrect movement of the joint, for example a front or rear drawer, as can be observed after ligament ruptures in a knee joint will.

In particularly advantageous embodiments, the frame joint orthosis can be combined with an elastic joint bandage, which is designed in the form of a closed or closable open hose. This allows the effects of the frame orthosis and the joint support to improve The therapy or treatment can be combined particularly well.

The elastic joint bandage can in particular have pockets to accommodate sections of the side rails and / or the adjustable-length clamps, so that the elastic joint bandage can be firmly connected to the frame joint orthosis. The pockets can be opened in order to enable the joint bandage to be separated from the frame orthosis, for example for cleaning purposes. The small size of the adjustable clamps makes them suitable for inclusion in the pockets of the elastic joint bandage.

Alternatively, the frame joint orthosis can also be placed loosely over the elastic joint bandage or vice versa. The compression effect of the joint bandage can be supplemented with the stabilization effect of a frame orthosis and thereby increase the flexibility and the success of a treatment or therapy.

The elastic joint bandage can also be positioned over the frame orthosis. The compression effect of the joint bandage in which the length-adjustable clamps surround the areas can be designed to be sufficiently strong so that the first and second clamp elements are pretensioned against one another in the sense of a reduction in the arc length of the clamp. This can enable an automatic adjustment of the arch length of the clamp within a certain range, e.g. when tensioning and relieving the muscle parts below. As a result, gaps between the clamps and the limb can be avoided even if the anatomy of the limb changes.

According to a further aspect of the invention, a tutor Joint splint created to limit a range of motion of an anatomical joint. The Tutor joint splint has a textile support which is determined and designed to be placed in a circular fit around a limb having the joint. The textile carrier contains closure elements in order to be held together in the form of a closed tube after it has been placed on the limb. In the preferred embodiment, the Tutor joint splint also has two continuous lateral splints which are provided for arrangement along the limbs having the anatomical joint for collateral stabilization and limitation or fixation of a range of motion of the joint. The seitli chen rails each have two or more thin, plate-shaped, flat slats in the unloaded state, which are arranged with their flat sides one above the other and which are flexurally elastic, longitudinally inelastic. The flexural elasticity of the lamellas allows flexibility of the rails in the direction of the thickness of the side rails for automatic adaptation to the outer contour of a longitudinal section of the limb that has the joint, simply by closing the textile carrier by means of the closure elements.

The Tutor joint splint according to the invention also uses flexible, leaf-spring-like elements or resilient lamellae, which when force is applied, a sufficient elastic deformation of the lamellae and the resulting side rails to adapt to the outer contour of the limb with the joint, for example. A leg with a Knee steer, allow. When the force is relieved, the slats spring back into their flat plate shape. Advantageously, the side rails can automatically hug the respective medial or lateral outside of the joint if the lamellae are pressed firmly against the respective limb sections simply by closing the closure elements. the. The lamellas and the side rails can then follow all local curvatures or bends of the respective outer contour on which they rest, so that even pressure is obtained along the limb section without local pressure points and a continuous stabilization of the joint along the limb is achieved can.

The side rails can be quickly and easily adapted to the respective anatomical conditions, the medial or lateral side of a respective left or right knee on legs of different shapes, e.g. so-called U, X or straight legs with different muscles.

The Tutor articulated splint can have side pockets formed on the textile support for receiving the side splints. The pockets can preferably be openable in order to detachably or interchangeably accommodate the side rails, e.g. to be able to wash the textile carrier if necessary. Advantageously, it is not necessary to remove the side rails for the purpose of adapting to the anatomical shape. The textile carrier can either be made in one piece or preferably composed of several, usually two or three parts, which can be connected to one another by suitable means, e.g. Velcro fastener elements.

Each side rail can have a stack of two or more, preferably at least three or four, essentially equally long, resilient lamellae. Apart from the fact that the stacks of lamellas now form the lateral stabilization rails of the Tutor hinged splints, are not connected to any other fixed elements, in particular not to fixed frame elements of a frame joint orthosis, and the lamellas overlap each other over their entire length, the lamellas of the Tutor Articulated splints are essentially similar to the slats of the frame joint orthosis, which is, for example, the material rialien, elasticity, dimensions, especially in the thickness and width direction, or their sheathing is concerned. Thus, the above explanations relating to the slats of the frame joint orthosis apply in the same way to the slats of the Tu tor articulated rails.

For example, the slats of the Tutor hinged splints can be made of metal, plastic, a metal-plastic composite or a fiber-reinforced plastic, with slats made of Fe derbandstahl or made of glass or carbon fiber-reinforced plastic. The thickness of each lamella can be less than 1 mm, preferably less than 0.5 mm, even more preferably less than or equal to 0.3 mm.

As in the case of the frame orthotic, the flexural elasticity of the lamellae can be so high that the lamellae can be elastically bent up to at least one essentially semicircular shape. It is at least sufficient to allow an automatic elastic deformation of the rails when the closure elements are closed from an essentially flat shape to a multiple curved shape with at least two changes in curvature. Then the side rails can cling to the respective limb sections tightly and essentially without gaps.

The Tutor hinge splint can furthermore have a cover which encloses the overlapping arrangement of the slats and prevents the slats from giving way in the direction of thickness and width. Advantageously, the sheath can in particular have a cut-resistant tube made of Kevlar or fiber-reinforced material as a cut protection.

The Tutor articulated splint can be designed without swivel or swivel joints, so that the slats and lateral Rails are continuously shaped and provide a stretched or, with a corresponding shape of the slats, a slightly bent position of the limbs. Alternatively, the side rails can each have a swivel or swivel joint that allows the side rails to rotate or swivel in an adjustable range in accordance with the flexion and extension movement of the anatomical joint. Each lateral rail then has rail elements or two sets of lamellas, which are connected to one another in a pivotable manner via the swivel or swivel joint.

Further advantageous details of the invention emerge from the dependent claims, the drawing and the associated description. In the drawing, exemplary embodiments of the subject matter of the invention are shown. Show it:

Figure 1 is a three-dimensional view of a frame orthosis for a knee in a slightly bent position, in a simplified representation;

FIG. 2 shows a plan view of the frame orthosis according to FIG. 1 in a relaxed, extended position, in a simplified representation, with details being omitted for the sake of clarity;

FIG. 3 shows a side view of a clamp of the orthosis according to FIGS. 1 and 2, illustrating the clamp elements and lamellae of the clamp elements in the relaxed state, in a simplified representation;

FIG. 4 shows a three-dimensional representation of the clamp from FIG. 3 in a fragmentary, exploded view, greatly simplified; FIG. 5 shows an arrangement of lamellae of a clamp of the orthosis according to FIGS. 1 and 2 in a modified embodiment with folding tabs, in a simplified representation;

FIG. 6 shows side views of a clamp of the orthosis according to FIGS. 1 and 2 in states with different overlapping lengths and different curvatures of the lamellae, in a highly schematic basic illustration to explain the mode of operation;

FIG. 7 shows a frame orthosis for a knee in combination with an elastic knee support according to a further embodiment of the invention;

FIG. 8 is a simplified perspective view of a Tutor joint splint for a knee, the Tutor joint splint being applied to a knee; and

FIG. 9 shows a cut-open Tutor articulated splint according to FIG. 8 in use on a knee, illustrating lateral splints formed from resilient lamellae, in a highly schematic basic illustration to explain the mode of operation.

FIG. 1 shows, in a simplified perspective illustration, a frame orthosis 1 for a knee according to an embodiment of the invention. Although the invention is illustrated and described in connection with a knee orthosis 1 for guiding and stabilizing a human knee joint, it should be understood that the frame joint orthosis 1 according to the invention for guiding and stabilizing any anatomical, human or animal joints, in particular knee joints , Elbow or ankle joints, set up or, if necessary, adapted with a few modifications for such applications. The principles of the invention remain ben on frame joint orthoses 1 for any anatomical Ge joints and indications applicable.

The embodiment of a frame joint orthosis 1 illustrated in FIG second, lower frame element 7. The first and the second frame element 7 are hereinafter also referred to as the first and second clamp 6, 7 in the art. Insofar as the terms "left", "right", "upper", "lower" or the like are used in the description for features or elements shown in the figures, these refer to the position that these elements have in the respective figure take in. This position or direction information does not necessarily have to match the direction or orientation that is visible to the patient when using the frame orthosis 1.

For example, the left rail 3 shown in FIGS. 1 and 2 represents the right rail for the user wearing the frame orthosis 1 and vice versa. In general, however, unless otherwise stated, the description in relation to a left (or top) element also applies in the same way for the right (or lower) element and vice versa. The same also applies to the terms “first” and “second”, which are used here only to better distinguish the elements, but are otherwise largely interchangeable.

The first and second rails 3, 4 are provided for arrangement along a leg (or generally a limb) having a knee (or generally a joint) for collateral guidance and stabilization of the knee joint. The rails 3, 4 are each designed as articulated rails that have a swivel or swivel joint 8 that enables the frame orthosis 1 to perform a movement that largely corresponds to the natural flexion and extension movement, in particular of a human knee. The swivel or swivel joints 8, 9 are designed essentially identically.

In the embodiment shown, each rail 3, 4 has two rail elements 11a, 11b or 12a, 12b, each of the rail elements 11a, 11b, 12a, 12b at one end on an axis of rotation 13a, 13b or 14a, 14b of the rotary or pivot joints kes 8 or 9 is rotatably mounted. The axes of rotation 13a, 13b or 14a, 14b of a respective swivel or swivel joint 8 and 9 are in meshing engagement with one another via a toothing not shown here, so that a Drehbewe movement of the rail element 11a or 12a with a correspond to the opposite directions Rotational movement of the other rail element 11b or 12b of the same rail 3 or 4 is associated. This allows polygon joint arrangements to be created that can easily reproduce the natural movement of the knee.

Although the swivel or swivel joints 8, 9 in the embodiment according to FIGS. 1 and 2 are designed with two interacting axes of rotation 13a, 13b and 14a, 14b per joint and thus form the polygon joint, each could alternatively only a single common axis of rotation can be provided on the bearing body 16 or 17 in order to mount the rail elements 11a, 11b or 12a, 12b rotatably thereon. Joints with more than two axes, for example 4-axis joints, can also be provided. In principle, the rails 3, 4 could also be set up without a swivel or swivel joint if a flexion and extension movement of a joint, for example a knee, is not necessary.

In addition, in any embodiment of rotary or swivel joints, including the inserts shown in FIGS. 12a, 12b can be pivoted relative to one another in the respective direction, and thus limit the permissible amount of flexion and extension movements of a joint, if necessary.

The pivot pins of the axes of rotation 13a, 13b, 14a, 14b can be arranged in a bearing body 16 or 17, which is arranged approximately in the middle of the respective rail 3, 4 and receives the ends of the rail elements 11a, 11b or 12a, 12b . On the inside of each bearing body 16, 17 facing the knee, pads 18 can be arranged in order to reduce the pressure against the knee joint and to avoid associated pain for the patient.

The clamps 6, 7 connect the first and second rails 3, 4 to one another at their outer ends and so together with the rails 3, 4 form the essentially rectangular, closed frame structure 2. The first, upper clamp 6 is connected to that of the end 19a of the rail element 11a remote from the swivel or swivel joint 8, here in particular rigidly connected to bending and twisting, while another end of the first th clamp 6 is firmly connected to the opposite end 21a of the rail element 12a remote from the swivel or pivot joint 9, in particular in a manner that is resistant to bending and twisting. The fixed connection can be achieved, for example, by rivets 22, which penetrate the ends of the first clamp 6 and the ends 19a, 21a of the rail elements 11a, 12a and fasten them firmly to one another.

In the same way, the second, lower clamp 7 can be fixed at one end to an end 19b of the further rail element 11b of the first rail 3 remote from the swivel or swivel joint 8, in particular in a rigid manner, for example by means of rivets 22 , while the opposite end of the second clamp 7 is fixed, in particular rigid and twisted, for example by means of rivets 22, to the end 21b of the further rail element 12b of the second rail 4 remote from the rotary or swivel joint 9.

If necessary, a rotatable connection to the rails 3 and 4 can also be provided on the first and / or the second clamp 6, 7. The structure of the clamps 6, 7 is explained in more detail below in connection with FIGS. 3 and 4.

Returning to FIG. 1, it can be seen that the frame joint orthosis 1 also has a fastening system which enables the orthosis 1 to be fastened 4-point to a limb, here on a leg of the patient. A 4-point attachment is in the applications envisaged here, he wishes to secure the orthosis 1 to the patient's leg and prevent slipping of the orthosis while wearing and the desired stabilization of the knee joint against displacement in a plane perpendicular to the main axis to reach. For example, with such a 4-point fastening System of a knee orthosis 1 a front drawer in the event of a rupture of the anterior cruciate ligament and a rear drawer in the event of a rupture of the posterior cruciate ligament can be effectively prevented. In the present case, the 4-point fastening system includes a number of Velcro strips which are arranged at different points along the rails 3, 4 in order to enable fastening to different positions or levels of a patient's leg.

In the example shown, both clamps 6, 7 are in front of ne, ie anterior, on the leg. Of course, it is also possible that one of the clamps 6, 7 is arranged on the front of the leg (anterior) and the other on the back of the leg (posterior). For example, it is known for frame orthoses for the knee that versions are used in which a clamp in the thigh area rests on the front of the leg, while another clamp is arranged in the lower leg area on the back of the leg, i.e. on the calf.

A first Velcro fastener tape 23 is arranged substantially at the level of the first clamp 6 at the free ends 19a, 21a of the rail elements 11a, 12a in order to be folded over and secured around the back of a thigh. A second Velcro fastener tape 24 is arranged in a similar manner at the level of the second clamp 7 at the free ends 19b, 21b of the rail elements 11b, 12b and is intended to be folded around the back of the lower leg or calf and secured thereon . Further Velcro straps 26a, 26b can be provided in the middle area of the upper rail elements 11a, 11b in order to span a thigh in an area slightly above the knee and to secure the orthosis 1 thereon. Even more Velcro straps 27a, 27b are attached in the middle area of the lower rail elements 11b, 12b. arranged and intended to span the lower leg in an area slightly below the knee and to secure the orthosis 1 on the leg and vice versa.

Instead of the individual Velcro straps 26a, 26b or 27a, 27b, a single Velcro strap 26 or 27 could be provided, which is placed and fastened around the entire circumference of the thigh or lower leg. In principle, other inelastic tension straps or other straps with fastening means that differ from Velcro fasteners, for example with clips, press studs or the like, are also possible.

In FIG. 1, the frame joint orthosis 1 is shown in a slightly kinked or bent state, in which the rail elements 11a, 11b and 12a, 12b are pivoted slightly towards one another. In addition, the first and the second clamp 6, 7 as well as the Velcro straps 23-27 are placed around the respective body sections of a patient's leg, not shown in detail here, and secured. In this to stand the rails 3, 4 are slightly towards each other verla Gert, and the clamps 6, 7 are curved or bent to follow the cross-sectional shape of the respective portion of the thigh or lower leg.

In Figure 2, the frame joint orthosis 1 is shown in a relieved state in which it is removed from a patient's leg and is not exposed to any external force. The frame orthosis 1 is then stretched in such a way that the rails 3, 4 with the joints 8, 9 are most distant from one another and the clamps 6, 7 assume an essentially flat shape. To make this possible, the clamps 6, 7 according to the invention are continuously adjustable in length and continuously flexible. The design of the clamps 6, 7 will now be explained in more detail with reference to FIGS. 3 and 4, which show an embodiment of a first or second clamp 6, 7 according to the invention, as illustrated in FIGS. FIG. 3 shows the clamp 6 or 7 in a simplified Seitenan view, while FIG. 4 shows the clamp 6 or 7 in perspective, excerpts in a simplified exploded view. Although the first clamp 6 is explained in more detail below in connection with FIGS. 3 and 4, it should be understood that the second clamp 7 according to FIGS. 1 and 2 can be designed essentially identically or at least similarly to the first clamp 6, so that Unless otherwise stated, the statements relating to the first clamp 6 generally apply in the same way to the second clamp 7, even if no specific reference is made to the second clamp 7.

Referring to FIGS. 3 and 4, it can be seen that the clamp 6 (or 7) is formed in two parts with a first clamp element 28 and a second clamp element 29. Each clamp element 28, 29 is secured to the respective end 19a (21a) or 19b (21b) of the first or second rail 3, 4 by means of the two rivets 22 here, so that they cannot be bent or twisted. In principle, the ends of the clip elements 28, 29 could also be rotatably supported relative to the rails 3, 4 by using only a single rivet 22, for example. In any case, the clip elements 28, 29 are advantageously connected to the side rails 3, 4 in a rigid manner, so that they can proceed essentially parallel from these at first and form a rigid frame.

The clamp elements 28, 29 extend from their fastening ends in the longitudinal direction 31 freely projecting aufeinan the and overlap each other in a central area of the Clamp 6 (or 7). Depending on the degree or length of the overlap 32 of the clamp elements 28, 29 results in a different length of the clamp 6 (or 7). The clamp elements 28, 29 can, as indicated in Figures 3 and 4 by double arrows, in the longitudinal direction 31 against each other, so towards or away from each other, be moved to the overlap length 32 of the clamp elements 28, 29 and thus the resulting length of the To change clamp 6 (or 7).

As can also be seen from FIGS. 3 and 4, each of the clamp elements 28, 29 has a number of thin lamellae. The first clip element 28 has first lamellae 33, while the second clip element 29 has second lamellae 34. The number of lamellas 33 or 34 per Schellenele element 28 or 29 can be selected as desired. Each clamp element 28, 29 has at least one lamella 33 and 34, respectively.

In the embodiment shown in FIG. 3, two first lamellae 33a, 33b for the first clip element 28 and two second lamellae 34a, 34b for the second clip element 28, 29 are provided for exemplary purposes only. The first lamellae 33a, 33b and the second lamellae 34a, 34b are arranged alternately one above the other in a stack, so that in the thickness direction 36 of the clamp 6 (or 7), as indicated in Figure 3, perpendicular to the longitudinal direction 31 above a lamella 33a of the first lamellae, a lamella 34a of the second lamellae is arranged, over which again a lamella 33b of the first lamellae follows and above that a lamella 34b of the second lamellae is arranged. FIG. 4 also shows only by way of example how a single second lamella 34 is inserted in a stack between two first lamellae 33a, 33b.

The lamellae 33, 34 are each made of thin, plate-shaped formed elements which, in the unloaded state, as illustrated in FIGS. 2 and 3, assume a substantially planar shape. The lamellae 33, 34 are made of a flexurally elastic material, but inelastic in the longitudinal direction 31. The flexural elasticity of the lamellae 33, 34 is very high in order to allow high flexibility or elastic deformability of the clamp elements 28, 29 in the circumferential direction around the longitudinal axis of a thigh or lower leg to adapt to the cross-sectional shape of the same.

The lamellae 33, 34 can consist of metal, plastic, a metal-plastic composite material or a fiber-reinforced plastic. In advantageous embodiments, spring steel sheets are used from a spring band steel. In further, particularly preferred embodiments, glass or carbon fiber reinforced plastics can be used for the lamellae 33, 34. These allow a particularly light construction of the clamp elements 28, 29 and thus the clamps 6 (or 7) with extremely high elastic deformability.

In order to further promote the elastic deformability, the thicknesses of the lamellae 33, 34 are also relatively small. The thickness of the lamellae is preferably less than 1 mm, more preferably less than 0.5 mm. In certain embodiments, the fins 33, 34 can be less than or equal to 0.3 mm thick. Thus, the thickness of the first and second Schel lenelementes 28, 29, even if they comprise several slats 33a, 33b or 34a, 34b, each relatively small and overall preferably smaller than the thickness of the side rails 3, 4 around the clamp elements 28, 29 a significantly lower flexural rigidity than the side rails 3, 4 to lend. A low bending stiffness of the clamps 6, 7 formed from the lamellae 33, 34 results from the stack of thin spring elements lying on top of one another and sliding on one another. ments.

The flexural elasticity of the lamellas 33, 34 can be so high that they cause elastic deformation of the first and second clamp elements 28, 29 perpendicular to the longitudinal direction 31 of the clamp 6 (or 7), for example along the circumference of an upper or lower leg of the Patients allowed up to at least one substantially semicircular shape. In this way, the respective area of the thigh or lower leg can be separated over half a circumference from the area indicated by the clamp elements 28,

29 formed clamp 6 and 7 are gripped. If the overlap length 32 of the clip elements 28, 29 is small, the ends of the clip elements 28, 29 connected to the rails 3, 4 can possibly even be elastically bent or brought together by up to 300 ° of a circumference or more.

In addition, the smaller thickness and flexural elasticity of the lamellae 33, 34 can also allow elastic twisting about the longitudinal axis 31 of the clamp elements 28, 29. For example, twisting by up to 5 ° or more can be possible. This can advantageously support the adaptation to the anatomy of a thigh, especially in the case of pronounced muscles.

The lamellae 33, 34 advantageously also have only a small width 37 (cf. FIG. 4), measured perpendicular to the thickness direction 36 and the longitudinal direction 31. The width 37 of the lamellas 33, 44 and in particular of the Schellenelemen te 28, 29 can essentially correspond to the width of the side rails. It can be smaller than the maximum width of the rails 3, 4. So that the clamps 6, 7 only ge ring and are felt by the patient as not very annoying. In addition, the small width also supports the elastic flexibility and twisting ability of the clamps 6, 7. The width 37 of the clamp elements 28, 29 can, if applicable also wishes to be larger, so that the clamps 6, 7 have a larger contact surface on the limbs and are less prone to cutting. If necessary, the clamp elements 28 and 29 can also have different widths.

As already mentioned, the second clamp 7 is essentially identical or similar to the first clamp 6. Since the clamps 6, 7 are intended for different areas of the limbs, e.g. for the thigh and lower leg area, the clamps 6, 7 can have a different number of slats 33, 34. For example, increased stability of the clamp 6 may be desired for the thigh area. In this respect, for example, the first bracket 6 can be formed with two or more first lamellae 33a, 33b and at least one, preferably two or more second lamellae 34a, 34b, while the second bracket 7 only has a single first lamella 33 and a single one may have two te lamella 34. The first clamp 6 can thus be made somewhat more stable than the second clamp 7.

The more lamellae 33, 34 the clamp 6, 7 has, the greater the static friction between the lamellae 33, 34, which although the relative displaceability of the lamellae 33, 34 somewhat inhibits one another, but does not prevent it. Conversely, the increased static friction can help to maintain a set length of the clamp 6 or 7, even if the length is not (yet) additionally fixed. The number of lamellas 33, 34 can be appropriately determined depending on the type and size of the patient's limb and the frame orthosis 1.

If it is not advantageous for the lamellas to slide on top of each other, but it is deliberately intended that the arc length of the clamps 6, 7 does not change automatically, NEN between the lamellae 33, 34 additional layers of egg nem material with high static friction can be arranged, or the lamellae 33, 34 can be beschich tet with such a material. Suitable materials for this are, for example, soft elastomers. It can also be advantageous that a strongly frictional connection is created, for example, by structuring the surfaces or by coating them with a rough material (eg sandpaper).

As can also be seen from FIGS. 1 and 2 and shown in more detail in FIGS. 3 and 4, each overlapping arrangement of the first and second clamp elements 28, 29 can be surrounded by a sheath 38 which encloses all of the lamellae 33, 34. The shell 38 thus prevents the lamellae 33, 34 from breaking out in the thickness direction 36 and the width direction 37 and holds all the lamellae 33, 34 together. In FIG. 3, the shell 38 is cut open in order to show the interior with the lamellae 33, 34.

The sheath 38 can in particular have an outer hose 39 which is pulled over the clamp elements 28, 29 so that it almost completely encloses the respective clamp 6 or 7 in the longitudinal direction 31. Only the fastening ends of the clamp elements 28, 29 can protrude outward from the hose 39.

In a particularly advantageous embodiment, the outer tube 39 is a heat-shrinkable tube which is able to contract when heat, for example hot air, is supplied. Preferably, the heat shrink tubing 39 is shrunk to match the clamps 6, 7 during manufacture of the frame orthosis in such a way that the package of lamellas 33, 34 received in its interior is securely held together and the lamellas 33, 34 are stably parallel in the event of a longitudinal displacement be guided. The heat shrink tubing 39 can make the adjustment process to adapt the frame orthosis 1 to the anatomy of a patient considerably easier and faster.

It could also be provided that the heat shrink tube 39 shrink during the process of adapting the frame orthosis 1 to the respective limb by supplying heat in such a way that the clamps 6, 7 are fixed invariably in their previously set arc length.

Instead of the heat-shrinkable tube 39, a non-shrinkable tube with a suitable diameter or with a width suitable for the width of the lamellae 33, 34 in the flat state could also be used.

The sheath 38 can also have a further, largely cut-resistant hose 41 which surrounds the lamellae 33, 34 and is inserted between the lamellae 33, 34 and the outer hose 39. The further tube 41 is made of a cut-resistant material. It can, for example, be made of a cut-resistant fiber, e.g. Kevlar fiber, braided, laid, woven, knitted or manufactured in some other way. It can also be reinforced by such a cut-resistant fiber, e.g. Kevlar fiber, which is embedded in a rubber or plastic hose. In any case, the further hose 41 offers effective protection against the sharp edges of the thin lamellae 33, 34 and also against abrasion by them, so that damage or even severing of the outer hose 33 by the lamellae 33, 34 can be effectively prevented. This also minimizes the risk of the patient being injured by the lamellae 33, 34 when the frame orthosis 1 is worn.

The frame joint orthosis 1 preferably also contains one Fixing device 42 for fixing the first and second clamp elements 28, 29 relative to one another after the ge desired or required overlap length 32 has been set according to the anatomy of a limb of the patient. In the embodiment of FIGS. 1-4, the fixing device 42 is advantageously set up in such a way that it only defines or limits the maximum length of the resulting clamp 6 or 7, so that the lamellae 33, 34, for example, when a muscle is stretched or when a external force cannot be pulled further apart. A displacement of the lamellae 33, 34 towards one another is furthermore possible. The fixing device 42 can be designed for non-positive, in particular frictional, fixing of the set overlap length of the clamp elements 28, 29.

As indicated in Figures 1 and 3, the fixing device 42 can in particular have an inelastic Velcro strip 43, which is arranged and effective to adjust the set distance between the ends 19a, 21a and 19b, 21b of the lateral rails 3, 4 , so to limit the maximum length of the clamp 6 or 7. As mentioned, this distance can be reduced if necessary, if, for example, the circumference of the limb spanned by the respective clamp 6 or 7 becomes smaller due to muscle contraction or decongestion.

The inelastic Velcro 43 of the fixing device 42 he stretches here starting from the end 21a of theienenele Mentes 12a with a first section over the outer surface of the outer tube 39 to the opposite end 19a of the rail element 11a, is there through an eyelet 44 and threaded knocked down. The Velcro strip 43 then runs back in the direction of the rail element 12a and is connected to a Velcro fastener element 46 provided at its free end fixed to a Velcro mating element of its first section. Instead of the ends 19a, 21a of the rails 3, 4, the Velcro 43 could also be fastened or threaded through the ends of the clamp 6.

The second clamp 7 preferably has the same fixation device 42 with an inelastic Velcro 43, which is fastened or threaded in the same way between the ends 21b, 19b of the rail elements 11b, 13b. In the Figu ren this Velcro 43 is for the sake of clarity let wegge. However, the description given in relation to the fixing device 42 for the first clamp 6 also applies analogously to the second clamp 7.

There are also other fixing devices for the längenver adjustable clamps 6, 7 for fixing the set length and curvature of the clamps 6, 7 possible. For example, the first Velcro strap 23 and the second Velcro strap 24 can also be designed such that they are completely folded around the entire circumference of the thigh or lower leg, including via the respective clamp 6 or 7, and secured by means of suitable Velcro elements will. The Velcro straps 23 and 24 then fulfill a double function of fixing the length and securing the orthosis 1 to the limb.

Instead of Velcro, other fixing devices, such as pin buckles, clamping buckles or similar devices, are of course also possible.

Another possible embodiment of a fixing device is illustrated in FIG. In this embodiment, at least one lamella, here for example a first lamella 33, on the longitudinal edges 47a, 47b of which are integrally formed laying tabs 48, which in the initial state protrude vertically outward from the respective longitudinal edges 47a, 47b and are arranged essentially in the same plane as the lamellar plate. The folding tabs 48 have predetermined bending points 49 at which the folding tabs 48 can be bent or folded over towards the lamella 33. FIG. 5 shows by way of example how a folding flap 48 ′ is folded over in such a way that it engages around the second lamella 34 lying above the first lamella 33 and presses it against the first lamella 33. If all Umle tabs 48 are turned in this way over all lamellae 33, 34, the lamellae 33, 34 are held together by sufficient frictional engagement and adhesion, so that in this way the parallelism, or congruence, of the Schel len elements 28, 29 is guaranteed and, if necessary, the set arc length of the respective clamp 6 or 7 can be fi xed.

The folding tabs 48 can also only be used to guide the slats 33, 34 in parallel. If the Umle tabs 48 are not pressed when folding, or if no targeted form fit is sought, then the lamellae 33, 34 remain displaceable against each other, so that an automatic adjustment of the arc length of the clamps 6, 7 can take place in the event of anatomical changes. For example, in advantageous embodiments in which the frame orthotic 1 is used in combination with a compression bandage connected to or overlying the clamps 6, 7, the compressive effect can be transmitted to the limbs by applying a compression through the compression bandage, without this effect being prevented by the clamps 6, 7 of the frame construction.

Other possible fixation means can bind in the manner of cables and Velcro strips can be formed around the overlapping arrangement of the first and second Schellenele Mentes 28, 29 are placed and tightened so that they are fixed in their set position relatively immovable or, for example, deliberately displaceable in one direction.

The frame joint orthosis 1 described so far works as follows:

It is assumed that the frame joint orthosis 1 is in the relaxed state illustrated in FIG.

9 define a swivel angle of 0 °. In this position, the clamps 6, 7 have a substantially flat or ebe ne shape.

The frame joint orthosis 1 can now be placed on the respective limb of a patient, here e.g. on a leg around a knee joint of the patient, in such a way that the swivel or swivel joints 8, 9 are arranged essentially at the level of the kneecap. This is done with the patient's leg extended. The frame orthosis 1 can then be placed around the circumference of the patient's thigh and lower leg by gently pressing the clamp 6, 7 against the ends 19a, 19b or 21a, 21b of the rail elements 11a, 11b,

12a, 12b are each pressed and displaced outwards and around the longitudinal axis of the patient's leg. As a result, the clip elements 28, 29 with the lamellas 33, 34 are increasingly pushed apart from one another, as a result of which their overlap length 32 is reduced. At the same time, they are elastically deformed essentially into a circular shape, so that they follow the surface shape of the underlying circumferential section of the respective thigh or lower leg. To correct the setting, the clamps 6, 7 can be gently pressed together again, so that the lamellae 33, 34 are shifted towards one another, whereby the overlap length 32 is shortened again. The flexible lamellas 33, 34 enable the clip elements 28, 29 to be easily folded around the respective circumferential section of the thigh or lower leg, while the clip ends are pulled apart or pushed together. In this way, the desired length of the clamp 6, 7 with the required curvature, as required by the anatomy of the patient's leg, can be set quickly and easily without any mechanical adjustment means. The joints 8, 9 can thus be very easily brought into the correct position medially and laterally of a knee joint.

The first and second Velcro fastener tape 23, 24 can then be placed around the respective rear side of the thigh and lower leg and secured using the Velcro fastener elements. Thereafter or before, the inelastic Velcro tape 43 of the fixing device 42 can be threaded through the eyelet 44, folded over and secured with the Velcro closure element 46, as a result of which the maximum length of each of the length-adjustable clamps 6, 7 is finally fixed or determined . Alternatively, other means, such as the first and second Velcro fastener tape 23, 24 or the folding tabs 48 (FIG. 5), can be fixed or not at all if the pre-fixing achieved by the parallel slats 33, 34 is sufficient.

Now the other Velcro straps 46a, 46b and 47a, 47b are secured to the respective areas of the thigh and lower leg slightly above and below the patient's knee in order to attach the frame orthosis 1 to the patient's leg using the 4-point mechanism and to keep it safe and slip-proof. In use, the patient's knee joint is stabilized by the frame orthosis 1 and, during a flexion and extension movement, is supported and guided physiologically and collaterally by the rails 3, 4. The clamps 6, 7 serve to stabilize the joint of the corresponding limb according to a general functional principle of frame orthoses known to those skilled in the art. By continuously adapting the length of the clamps 6, 7 and their curvature or arching, the clamps 6, 7 can fit tightly to the respective circumferential section of the thigh or lower leg without gaps, so that they fit well to the respective cross-sectional profile in this area adjust. To a certain extent, the flexible clamps 6, 7 can also compensate for local elevations and depressions that are formed by the muscle parts in these areas. The Schel len 6, 7 are suitable in this way to exert a substantially uniform compression pressure on the thigh or lower leg in the encompassed circumferential section, especially if a compression bandage, as already described above, is also used. The compression pressure counteracts a possible swelling, can have an effect promoting blood circulation or muscle activity and a massage effect, which can be advantageous for the healing or treatment success.

If the clamps 6, 7 have to be readjusted in the course of therapy or treatment, this can also be done quickly and easily. If, for example, the circumference of the thigh or lower leg decreases due to muscular atrophy, only the clamp elements 28, 29 have to be pressed together accordingly in order to obtain the desired or required length and curvature of the clamp 6, 7. In this way, all the gaps that have arisen between the clamp 6,

7 and the thigh or lower leg eliminated and the desired compression pressure around the upper and lower leg area to be restored. Then the Velcro 43 of the fixing device 42, if present, can be loosened, tightened and secured again in order to set the newly set maximum length of the respective clamp 6, 7.

A similar adjustment process takes place if, due to muscle build-up or swelling of the limbs, the clamps 6, 7 must be made longer and have to be stretched further. In this case, the readjustment is carried out by loosening the Velcro strip 43, if present, then pulling the ends of the respective clamps 6, 7 apart to move the clamp elements 28, 29 away from each other until the desired resulting length of the clamps 6, 7 is set, applying the orthosis 1 to the corresponding limb in order to bring about the required curvature of the clamps 6, 7 and then securing the Velcro strip 43 to fix the newly set arc length and curvature accomplished. If necessary, the Velcro straps 23-27 must also be readjusted accordingly.

FIG. 6 illustrates how, with different cross-sectional profiles of a limb, here simplified with playful circular shapes of different diameters, of a patient's leg, different overlap lengths 32a, 32b and different radii of curvature of the clamps 6,

7 result. The frame orthosis 1 according to the invention enables adaptation to the individual size of the patient's anatomy in a wide range, so that one size of the frame joint orthosis 1 can universally cover many sizes or diameters of patient's limbs. There is no need to reserve a large number of different frame orthosis sizes.

This is made possible by the thin, flexible leaf spring elements or lamellae 33, 34, which allow the continuous length adjustment and continuous adjustment of the curvature of the Clamps 6, 7 allow over a wide range in an easy manner and with simple, inexpensive means.

Numerous modifications are possible within the scope of the invention. For example, different special designs of the frame orthosis 1 are conceivable. In particular, the frame orthotic 1 can be specially adapted or modified for use on a special joint, for example a knee joint, an elbow joint, an ankle joint or a hip joint. A 4-point attachment is not required in all applications, and other attachments are also possible. The flexible, length-adjustable clamps 6, 7, however, always allow optimal adaptation to the specific anatomy of an individual patient as well as easy and quick adjustment in the course of treatment or therapy in the event of changing anatomical conditions.

There are also, as already mentioned above, different means for the fixing device 42 for fixing the maxima len length of the clamps 6, 7 or for the absolute fixation of the water length possible. For example, the heat-shrink tubing 39 could be used to press the previously set lamellae 33, 34 with one another in such a way that longitudinal displacement is blocked. If necessary, additional layers could then be introduced that increase the static friction of the lamellae 33, 34 on one another. For example, a rough surface, such as sandpaper, can be applied to increase a frictional connection between the lamellae 33, 34. It could also be glued line velor with in the area of the contact of two lamellas 33, 34 opposite line direction be used in order to inhibit or block a relative displacement of the lamellas 33, 34 in one direction. If on mutually facing surfaces of the lamellae 33, 34 in opposite directions line velours with different line directions is applied, then the mutual displaceability in both directions can be inhibited or blocked when the lamellae 33, 34 with the intermediate line velours perpendicular to the thickness of the clamps 6, 7 are compressed. Additionally or alternatively, the lamellae 33, 34 could also be fixed by form-fit elements provided between or on the lamellae 33, 34, which can in particular also be brought into engagement with one another by the shrink tube 39. The form-fit elements could be formed by cams and recesses, barb elements or similar constructions.

It is also possible for only one of the clamps 6 or 7 to be provided. Each clamp element 28, 29 can only have a single lamella 33 or 34 or two or more lamellae 33 or

34 included. In many places where the clamps 6, 7 and the side rails 3, 4 come into contact with the limb of the patient, cushioning elements can be provided to reduce the pressure and increase wearing comfort.

An advantageous embodiment of the invention is illustrated in FIG. 7. In this embodiment, the frame joint orthosis 1 is combined with an elastic joint bandage 51, which is designed here in the form of a closed tube and is pulled over the respective limb, here a patient's leg and knee joint. In the exemplary embodiment shown, the joint bandage 51 can have a first, upper pocket 52 in FIG. 7, and a second, lower pocket 53, which are set up to accommodate the respective first and second clamps 6 and 7, respectively. The joint bandage 51 can thus be connected to the frame orthosis 1 in a fixed, possibly detachable manner.

Otherwise, the joint bandage is conventional arbitrarily designed. It can, for example, have cushions 54 in the knee disk area and also in the side area, in which case the cushions 18 of the frame joint orthosis 1 can be omitted.

In any case, the combination of the joint bandage 51 and the frame orthosis 1 enables a combination of the support, compression and massage effects that are achieved by the elastic joint bandage 51 in the entire enclosed area of the limb, here the enclosed leg, with the supporting, stabilizing and leading effects of the frame orthosis 1 and also in combination with the additional compression effect made possible by the adjustable, flexible clamps 6, 7.

In further variants, instead of the pockets 53, 54 or in addition to these, pockets for holding the side rails 3, 4 of the frame orthosis 1 can be provided on the joint bandage 51 in order to connect the frame orthosis 1 to the joint bandage 51 in these areas. The frame joint orthosis 1 can also be fixed to the joint bandage 51 by other means, such as for example Velcro elements, Velcro straps, snap fasteners, zippers or the like.

In some embodiments, the frame orthosis 1 and the joint bandage 51 do not need to be attached to one another.

The frame orthosis 1 is then simply placed over the joint bandage 51 and attached to the limb. A reverse arrangement is also possible, in which the elastic joint bandage 51 is placed over the frame orthosis 1. In this case, the elastic joint bandage 51 can also ensure that a previously set maximum length of the shell 6 or 7 is caused by the compression effect of the elastic joint. Steering bandage 51 is fixed in this area, but sliding of the slats 33, 34 towards one another is not hindered. An additional fixing device 42 is not required. The clamps 6, 7 can be loaded by the joint bandage 51 in such a way that the clamp elements 28, 29 are pretensioned towards one another in the sense of a displacement. This preload can be sufficient so that, for example, in the event of muscle atrophy or muscle contraction, the clamp elements 28, 29 automatically move towards one another and thus the length of the clamp 6, 7 is automatically reduced. The compression effect can also be sufficiently small to allow an automatic expansion of the clamps 6, 7 in the event of muscle stretching or muscle building.

In a further embodiment, for example, elastic bands can be provided which are tensioned on the clamps 6, 7 in such a way that they pretension the clamp elements 28, 29 in the sense of a shift towards one another, i.e. a reduction in the length of the respective clamp 6, 7. If the peripheral area of the limb surrounded by the clamp 6 or 7 becomes smaller, the elastic straps can then automatically bring about an adjustment by shortening the length of the respective clamp 6 or 7.

FIG. 8 shows a simplified perspective view of a Tutor articulated splint 61 for a knee according to a further embodiment of the invention in a state applied to a knee. Such tutor joint splints are used for postoperative care after surgical interventions on joints, here in particular knee joints, to immobilize or limit a range of motion of the joint. If a tutor joint splint 61 for a knee is shown here, it goes without saying that the tutor joint splint 61 according to the invention can be used to limit the movement of any anatomical mixer, human or animal joints, in particular knee, elbow or ankle joints, set up or, if necessary, adapted with a few modifications for such applications. The principles of the invention remain ben on Tutor articulated splints 61 for any anatomical joints and indications applicable.

The Tutor articulated splint 61 consists essentially of a textile support 62, locking elements 63 and two lateral splints 64, 66 Knee joint, formed to be placed around the leg and the knee joint 67 and secured by means of a Velcro fastener at the overlap in the front area and by means of the closure elements 63 as a closed hose or tube. The textile carrier can either be formed in one piece or composed of several, usually 2 or 3 parts. In the latter case, the textile carrier can be adapted to a larger extent to the dimensions of the limb of the wearer by assembling the at least two components individually and using the Velcro connections usually provided in the known designs to form an overall textile element. The hose thus formed by the textile carrier 62 together with its Velcro fastener and the closure elements 63 is adjustable in its circumference and can thus be adapted to the leg with the knee joint in a circular manner.

The textile carrier 62 contains a first carrier section 68, which is arranged above the knee joint 67 in use and attached to the thigh, and a second carrier section 69 which is attached below the knee joint 67 in use. arranges and is attached to the lower leg. The first and second support sections 68, 69 are connected to one another and are preferably formed from a one-piece blank and, in the closed tubular state, define an opening 71 above the kneecap which provides access to the knee and enables treatment, ventilation and cooling of the knee.

The closure elements 63 serve to hold the textile carrier 62 together and on the leg after it has been placed on the leg in the form of a closed tube. You are here by Velcro straps 72 and associated eyelets 73 gebil det. In the present example, three first Velcro straps 72a and associated eyelets 73a are provided on the first, upper carrier section 68 in order to secure the textile carrier 62 on the thigh. Two second Velcro straps 72b and associated eyelets 73b are provided on the second, lower support section 68 in order to secure the textile support 62 on the lower leg. The number of closure elements 63 can be selected as desired or required. As can be seen, the Velcro straps 72a, 72b and associated eyelets 73a, 73b can be arranged in the longitudinal direction alternately left (here lateral) and right (here medial) in order to evenly share the tensile stresses on the eyelets and pressure loads on the leg.

The textile carrier 62 contains a first pocket 74 on the lateral side of the knee joint 67 when in use and a second pocket 76 on the medial side. The pockets 74, 76 run along the textile carrier 62 over essentially its entire length. The pockets 74, 76 could have a closable access opening (not shown here) at one end, for example the upper end in FIG. 8, in order to accommodate the rails 64, 66 in the interior of the pockets and to be able to remove them if necessary . In any case, a first lateral rail 64 is received in the first pocket 74, while a second lateral rail 66 is received in the second pocket 76. The side rails are indicated in Figure 8 only by dashed lines and shown in more detail in Figure 9, in which the pockets 74, 76 are shown cut open and the Velcro fastener elements 63 are only indicated by dashed lines to facilitate illustration. The side rails 64, 66 serve to limit or block the range of motion of the knee joint 67. For this purpose, they are relatively stiff in the direction forwards and backwards with respect to the knee joint 67.

In the lateral and medial direction, the splints are designed to be relatively flexible in order to adapt them to the respective anatomy of the leg with the knee joint 67. For this purpose, the side rails 64, 66, as can be seen in particular from FIG. 9, each have a stack of several thin, plate-shaped leaf spring-like lamellae 77 which are flat in the unloaded state. The lamellae 77 lie with their flat sides on top of one another and are flexurally elastic in the thickness direction, but inelastic in the longitudinal and width directions. The flexural elasticity of the lamellae 77 enables flexibility of the rails 64, 66 in the thickness direction, which enables automatic adaptation to the outer contour of the longitudinal section of the leg containing the knee joint 67 simply by closing the textile carrier 62 by means of the closure elements 63.

The side rails 64 and 66 can be designed largely identical and each have the same number of two or more, preferably at least three or four, essentially equally long resilient lamellae 77 have. sen. The lamellae 77 can be essentially similar to the resilient lamellae 33, 34 of the frame joint orthosis 1, as far as the materials, elasticity, dimensions in thickness and width direction are concerned, so that the description there, unless otherwise stated, is the same Way for the slats 77 of the side rails 64, 66 of the tutor

Articulated splint 61 applies.

For example, the lamellae 77 can consist of metal, plastic, a metal-plastic composite or a fiber-reinforced plastic, with spring steel strip or glass or carbon fiber-reinforced plastics being preferred. The thickness of each lamella 77 can be less than 1 mm, preferably less than 0.5 mm, more preferably less than or equal to 0.3 mm. The lamellae 77 are in close contact with one another over the entire length of the rails 64, 66. In FIG. 9, the lamellas 77 are only shown, for reasons of drawing and clarity, relatively thicker and in some cases with gaps between one another.

The flexural elasticity of the lamellae 77, like that of the lamellae 33, 34, can be selected to be so high that the lamellae 77 can be individually bent elastically to a substantially semicircular shape. The flexural elasticity should in any case be sufficient to allow automatic elastic deformation of the rails 64, 66 when closing the locking elements 63 from an essentially flat shape to the multiple curved shape shown in FIG. 9 with two or more changes in curvature or turning points corresponding to the outer contour of the leg. Then the side rails can cling to the respective limb sections tightly and essentially without gaps.

The Tutor hinge splint 61 may have a shell that encloses the package of lamellae 77 and prevents the lamellae 77 from giving way in the direction of thickness and width. Before geous enough, the sheath can in particular have a schnittfes th hose 78 made of Kevlar or fiber reinforced material as a cut protection. The cut-resistant tube 78 and a cover as a whole can optionally also be omitted if the material of the side pockets 74, 76 is sufficiently cut-resistant.

The Tutor articulated splint 1 is formed in the case shown free of swivel or pivot joints on the side rails 64, 66. The lamellae 77 and the lateral rails 64, 66 are thus continuously shaped and have a length that essentially corresponds to the length of the pockets 74, 76 and largely to the total length of the Tutor articulated rail 1. The lamellae 77 have an elongated and rectangular shape in plan view, so that in use the anatomical joint, here the leg, is fixed in a fully extended position corresponding to a flexion angle of 0 °. The lamellae 77 could also have a pre-made bent shape in the plane of the sheet in order to hold the joint in a bent position before given, different from 0 °.

In a further modified embodiment, the side rails 64, 66 can each have a rotating or pivoting joint (not illustrated) that allows the lateral rails 64, 66 to rotate or pivot in accordance with the flexion and extension movement of the anatomical joint, here the knee joint 67, allowed up to a certain, specifiable degree. Each lateral rail 64, 66 then has two sets of lamellas, which are connected to one another in a pivotable manner via the swivel or swivel joint.

To use the Tutor joint splint 61 is around the Limb section which has the joint in question, here for example around a leg section comprising a knee joint, as indicated in FIGS. with the desired strength tightly secured to a closed hose or tube. When closing the closure elements 63, the lateral rails 64, 66 automatically nestle against the respective medial or lateral outside of the leg section. The flexible leaf spring-like lamellae 77 are very resilient, so that when closing the closure elements 63 they actively deform themselves elastically in such a way that they closely follow the outer contour of the leg and the knee joint 67 encompassed by the tutor joint splint 1 over their entire length can put on the leg without leaving gaps in some areas between the tutor joint splint 1 and the leg and without generating locally excessive pressure points. The tutor joint splint 1 is then largely optimally adapted to the individual anatomy of the respective limb section, here the leg section. Advantageously, several tests and fittings do not have to take place in advance for this purpose, during which a skilled orthopedic technician can individually place the side rails 64, 66 on several of them in accordance with the leg contour

Bend places and the patient has to try the Tutor joint brace on until it is reasonably well adjusted.

As can also be seen from FIGS. 8 and 9, a natural knee joint, for example, is essentially convex on the inside (medial), viewed from the front or back, along the leg, while on the outside (laterally) it is more concave. The outer contour along a leg with the knee joint has different local curvatures or bends on both the lateral and the medial side in the area of the knee as well as several re change of curvature, which the side rails 64, 66 according to the invention can each absorb well by virtue of their high inherent elasticity. Knee misalignments, such as the X and U-leg settings, are also automatically recorded. Despite the provided elasticity in the thickness direction, the support function of the Tutor joint splint in the sense of preventing or limiting the extension and flexion movement of an anatomical joint, especially the knee joint, can be achieved by the high rigidity of the splints 64, 66 in all directions perpendicular to the thickness direction be ensured.

It is a frame joint orthosis 1 for guiding and stabilizing an anatomical joint, in particular a knee joint, with a self-supporting frame structure 2 created. The frame joint orthotic 1 has two lateral rails 3, 4 for collateral guidance and stabilization of the joint and at least one clamp 6, 7 connecting the lateral rails 3, 4, which in use surrounds the limb in sections around the circumference. The clamp 6, 7 is infinitely adjustable in length and continuously elastically flexible ausgebil det. The clamp 6, 7 contains a first and a second clamp element 28, 29, each of which is rigidly connected at one end to one of the side rails 3, 4 to run on top of each other and overlap each other, the overlap length 32 being achieved by moving the clamp elements 28,

29 is continuously adjustable in the longitudinal direction towards or away from one another. Each clamp element 28, 29 has one or more thin, plate-shaped, in the unloaded to stand flat lamellae 33, 34, which are flexible, longitudinally un elastic. A Tutor articulated splint 61 with a textile support 62 and lateral splints 64, 66 formed from resilient lamellae 77 for limiting a

Flexion and extension movement of a joint is also disclosed.

Claims

Patent claims:

1. Frame joint orthosis for guiding and stabilizing an anatomical joint with a self-supporting frame structure (2), which has: two lateral rails (3, 4) which are provided for arrangement along a limb having the joint for collateral Füh and stabilization of the joint , and at least one clamp (6, 7) connecting the side rails (3, 4), which is provided to enclose the limb from sections around the circumference, the at least one clamp (6, 7) continuously adjustable in length and continuously elastic is designed to be bendable, the at least one clamp (6, 7) containing a first and a second clamp element (28, 29), each of which is rigidly connected at one end to one of the side rails (3, 4), to run towards one another and overlap pen each other, the overlap length (32) by shifting the clamp elements (28, 29) in the longitudinal direction of the same relative to each other infinitely adjustable ar, wherein each clamp element (28, 29) has one or more thin, plate-shaped, in the unloaded state flat lamellae (33, 34) which are flexible, longitudinally inelastic, the bending elasticity of the lamellae (33,

34) allows flexibility of the clamp elements (28, 29) in the circumferential direction around a longitudinal axis of the limb for stepless, continuous adaptation to the cross-sectional shape of the limb.

2. Frame joint orthosis according to claim 1, wherein the lamellae (33, 34) made of metal, plastic, a metal-plastic composite or a fiber-reinforced plastic, in particular glass or carbon fiber reinforced plastic, be available.

3. Frame joint orthosis according to claim 1 or 2, wherein the thickness of the first and the second clamp element (28,

29) is smaller than the thickness of the side rails (3, 4), the thickness of each lamella (33, 34) being less than 1 mm, preferably less than 0.5 mm, more preferably less than or equal to 0.3 mm amounts to.

4. Frame joint orthosis according to any one of the preceding claims, wherein the flexural elasticity of the lamellae (33, 34) allows an elastic deformation of the at least one clamp (6, 7) from a substantially planar shape to at least one substantially semicircular shape.

5. frame joint orthosis according to any one of the foregoing claims, wherein the flexural elasticity of the lamellas (33, 34) allows elastic twisting of the clip elements (28, 29) about the longitudinal axis up to a few degrees.

6. Frame joint orthosis according to any one of the preceding claims, wherein the lamellae (33, 34) have a width which corresponds substantially to the width of the side rails (3, 4) or is smaller.

7. Frame joint orthosis according to any one of the preceding claims, wherein at least one of the first and the second clip element (28, 29) has two or more lamellae (33a, 33b; 34a, 34b) and wherein the lamellae (33a, 33b) of the first clamp element (28) and the lamellae (34a, 34b) of the second clamp element (29) are alternately stacked one on top of the other.

8. Frame joint orthosis according to any one of the preceding claims, which has two continuously adjustable and continuously elastic bendable clamps (6, 7) each having the same aligned, opposite ends (19a, 19b; 21a, 21b) of the side rails (3, 4) connect with each other.

9. Frame joint orthosis according to any one of the preceding claims, further comprising a shell (38) which encloses the overlapping arrangement of the first and second clamp elements (28, 29) and an evasion of the lamellae (33, 34) in thicknesses - and width direction prevented.

10. Frame joint orthosis according to claim 9, wherein the sheath (38) has an outer tube (39), in particular a heat shrink tube.

11. Frame joint orthosis according to claim 10, wherein the Hül le (38) further comprises a further, cut-resistant tube (41) which surrounds the lamellae (33, 34) and between the lamellae (33, 34) and the outer tube (39) is inserted.

12. Frame joint orthosis according to any one of the preceding claims, further comprising a fixing device (42) for fixing the first and second clamp elements (28,

29) relative to one another in order to define a maximum length of the at least one clamp (6, 7).

13. frame joint orthosis according to any one of the foregoing claims, which comprises means which are set up are to the first and second clamp elements (28, 29) in Sin ne a reduction in the length of the at least one clamp (6,

7) to be biased against each other.

14. Frame joint orthosis according to any one of the foregoing claims, wherein the side rails (3, 4) each have a swivel or pivot joint (8, 9), the egg ne rotational or pivoting movement of the side rails (3, 4) corresponding to the Flexion and extension movement of the anatomical joint allowed.

15. Frame joint orthosis according to any one of the preceding claims, further comprising inelastic tension elements (23, 24, 26a, 26b, 27a, 27b), in particular locking straps, around the frame joint orthosis (1) by a 4-point attachment to the limb to secure.

16. Frame joint orthosis according to any one of the foregoing claims, which is further combined with an elastic Ge joint bandage (51) which is in the form of a closed or open, closable hose.

17. Frame joint orthosis according to claim 16, wherein the elastic joint bandage (51) has pockets (52, 53) to accommodate sections of the side rails (3, 4) and / or the at least one adjustable-length clamp (6, 7) to accommodate the to connect elastic joint bandage (51) with the frame joint orthosis (1).

18. Tutor articulated splint for limiting a range of motion of an anatomical joint, comprising: a textile support (62) which is determined and designed to pass circularly around a limb having the joint. send to be placed, and closure elements (63) to be held together after being applied to the limb in the form of a closed tube; two side rails (64, 66), which are provided for arrangement along the limb having the joint to limit a range of motion of the joint, and wherein the side rails (64, 66) each have two or more thin, plate-shaped, flat in the unloaded state Has lamellae (77), which are arranged with their flat sides one above the other and which are flexible, longitudinally un elastic, the bending elasticity of the lamellae (77) a flexibility of the lateral rails (64, 66) in the direction of the thickness of the rails (64, 64, 66) for automatic adaptation to the outer contour of a longitudinal section of the limb having the joint by closing the textile carrier (62) by means of the closure elements (63).

19. Tutor articulated splint according to claim 18, wherein the tex tile carrier (61) has side pockets (74, 76) for preferably releasably receiving the side rails (64, 66).

20. Tutor articulated splint according to claim 18 or 19, wherein each lateral splint (64, 66) has a stack of two or more, essentially equally long, resilient lamellae (77), the lamellae (77) made of spring steel sheet or a fiber-reinforced plastic consist, the thickness of each lamella (77) is less than 1 mm, preferably less than 0.5 mm, even more preferably less than or equal to 0.3 mm, and wherein the flexural elasticity of the lamellae (77) is an automatic elastic deformation of the Rails (64, 66) at

Closing the closure elements (12) by a substantially flat shape up to a multiple curved shape with at least two changes of curvature we allows.

21. Tutor articulated splint according to one of claims 18-20, further comprising a sheath which encloses the overlapping arrangement of the slats (77) and prevents the slats (77) from deflecting in the thickness and width directions, the sheath preferably having one Has cut-resistant hose (78).

22. Tutor articulated splint according to one of claims 18-21, wherein the side rails (64, 66) each have a rotary or

Have swivel joint that allows a rotary or pivoting movement of the side rails (64, 66) in accordance with the flexion and extension movement of the anatomical joint, each de side rail (64, 66) having two packets of lamellae (77), which over the rotation - Or swivel joint are pivotally connected to one another.