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United States Patent 3,835,849
McGuire September 17, 1974

BONE CLAMP AND ADJUSTABLE DRILL GUIDE

Abstract

A bone clamp for aiding a surgeon in positioning bones and securing them together and having means for properly orientating drills so that aligned holes may be drilled through the two bones, and also having means for locating the screw to be inserted through the bones to hold them together. One member of the clamp includes a generally V-shaped portion which can be inserted under the innermost bone so that the latter can be accurately located with respect to the guide means for positioning the drills and screw.


Inventors: McGuire; George (Depere, WI)
Appl. No.: 05/327,137
Filed: January 26, 1973


Current U.S. Class: 606/96
Current International Class: A61B 17/16 (20060101); A61B 17/17 (20060101); A61B 17/88 (20060101); A61f 005/04 ()
Field of Search: 128/92EB,92R,92BA,83

References Cited

U.S. Patent Documents
2200120 May 1940 Nauth
2531734 November 1950 Hopkins
2536963 January 1951 Stephens
2607339 March 1952 Price
3727611 April 1973 Schultz
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Nilles; James E.

Claims



I claim:

1. A bone clamp for holding two bones together in proper relationship while drilling said bones and inserting a screw therein, said clamp comprising, a first member having an elongated threaded portion and a generally V-shaped bone holding portion which is offset from said threaded portion, a second member slidably engaged on said first member and having an elongated opening therethrough including a central portion which is alignable with said V-shaped portion, a nut threadably engaged on said threaded portion for forcing said members toward one another so that said first and second members clampingly engage said two bones therebetween with one of said bones being located in said V-shaped portion, and a pair of drill guide members shiftably mounted in said opening and selectively shiftable into said central portion in said opening in alignment with said bones and said V-shaped portion, said guide members each having an aperture for receiving a drill for drilling through said bones, and said V-shaped portion defines a limit of drill travel.

2. The clamp set forth in claim 1 further characterized in that said guide members can both be shifted in said opening to a position out of said central portion of said opening after performing their drill guiding function, and screw means can be inserted in said central portion of said opening in alignment with the holes formed by said drills in said bones.

3. The clamp defined in claim 1 further characterized in that said threaded portion of said first member is non-circular in cross section, and said second member has an aperture therethrough for slidably receiving said threaded portion, said aperture being of a complementary shape to said threaded portion to prevent relative rotation between said clamp members.

4. The clamp defined in claim 2 further characterized in that said threaded portion of said first member is non-circular in cross section, and said second member has an aperture therethrough for slidably receiving said threaded portion, said aperture being of a complementary shape to said threaded portion to prevent relative rotation between said clamp members.

5. A bone clamp for holding two bones together in proper relationship while drilling said bones and inserting a screw therein, said clamp comprising, a first member having an elongated threaded portion and a generally V-shaped bone locating and holding portion which is offset from said threaded portion, said V-shaped member terminating in a sharp free end, a generally flat second member having an aperture for slidable mounting on the threaded portion of said first member and also having an elongated opening therethrough including a central portion which is alignable with said V-shaped portion, a nut threadably engaged on said threaded portion for forcing said members toward one another to clampingly engage said two bones between said member with one of said bones being located in said V-shaped portion, and a pair of drill guide members shiftably mounted in said opening and selectively shiftable into said central portion in said opening in alignment with said bones and said V-shaped portion, said guide members each having a hole therein for receiving a drill for drilling into said bones, said V-shaped portion acting as a stop for said drill to limit drill travel.

6. The clamp set forth in claim 5 further characterized in that said guide members can both be shifted in said opening to a position out of said central portion of said opening after performing its drilling function, and screw means can be inserted in said opening in alignment with the holes formed by said drills in said bones.

7. The clamp defined in claim 5 further characterized in that said threaded portion of said first member is non-circular in cross section, and said hole in said second member slidably receives said threaded portion being of a complementary shape to said threaded portion to prevent relative rotation between said clamp members.
Description



BACKGROUND OF THE INVENTION

The present invention pertains to surgical instruments and more particularly to a clamp for aiding the surgeon in properly positioning the bones or bone-like members that must be secured together during the healing process. In operations of this character, it is desirable to perform the operation with a minimum amount of cutting or opening of the patient and yet on the other hand, sufficient access to the injured area must be had to enable the surgeon to properly locate the broken or dislocated bones and hold them in proper relationship while the necessary drilling is performed on the bones so as to provide holes for the securing screw to be inserted through the bones. Furthermore, in operations of this type, it is essential that the drills do not penetrate the members further than absolutely necessary so as to avoid injury to nerves, muscles, or other body parts located in the adjacent area. It is furthermore essential that the required holes be drilled with precision through the bones to be fastened, so that the screws can be inserted in the properly aligned holes and precise location of the bones maintained during the screw fastening operation. Many bones are generally circular in cross section and consequently, it is difficult to drill a hole transversely into such a bone and particularly to have such a hole then properly aligned with the bone to which it is to be attached.

Another requirement for clamping devices of this character is that they be capable of being rendered absolutely sterile.

Prior art surgical clamps of this general type have been proposed but have had several shortcomings, such as the inability to easily render them sterile and disassembling them for cleaning purposes. Furthermore, such clamps did not always aid the surgeon in securely holding the dislocated or broken bones in proper position relative to one another while drilling the holes therethrough. Furthermore, it was difficult to then align the holes so drilled during the screw driving process. Use of these prior art devices sometimes resulted in improperly drilled holes, either as to location, direction, or as to the extent of drilling, and consequently damage to the bones or surrounding tissues or nerves occurred.

An example of a prior art bone clamp for clamping together two parts of the same bone and providing a drill guide is shown in the U.S. Pat. No. 2,181,746 issued Nov. 28, 1939 to Siebrandt for "Combination Bone Clamp and Adjustable Drill Guide" and also in U.S. Pat. No. 2,200,120, issued May 7, 1940 to Nauth for "Fracture Nail Guide" for only guiding the nail through two broken parts of a single bone. Still other examples of prior art bone clamps are shown in the U.S. Pat. No. 3,477,429 issued Nov. 11, 1969 and U.S. Pat. No. 2,460,470 issued Feb. 1, 1949.

SUMMARY OF THE PRESENT INVENTION

The present invention provides a bone clamp for holding bones or the like firmly and correctly together, permitting a hole to be accurately drilled through bones to be joined and insuring that the hole being drilled only extends to the proper depth through the bones and the drill is prevented from extending through the bones and into surrounding nerves or the like. The clamp also insures that a counterbore can be accurately drilled in one bone so the latter can freely accept the threaded portion of the screw while the other bone is engaged by the threaded portion of the screw. The clamp also insures proper location of the screw in respect to the drilled holes during the screwing operation, all this being accomplished while the bones are accurately held together.

The present invention provides a bone clamp of the above type which can be inserted into the body and located around the two bones to be clamped together with a minimum of disturbance of the surrounding tissues, muscles, nerves, etc.

Furthermore, the improved bone clamp can be easily manipulated during the operation so as to position guide means for the drill, the counterdrill and the screw. In addition, the clamp may be readily removed after the operation with a minimum disturbance to the surrounding parts.

The present invention provides a combination bone clamp and adjustable drill guide means of the above type and which finds particular utility in operations relating to the shoulder area and more particularly to the coracoid process and clavicle.

These and other objects and advantages of the present invention will appear hereinafter as this disclosure progresses, reference being had to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a bone clamp and drill guide means made in accordance with the present invention;

FIG. 2 is a plan view of the clamp shown in FIG. 1;

FIG. 3 is an end view of the clamp shown in FIG. 1, certain parts being shown in section for the sake of clarity; the view being taken generally along the line 3--3 in FIG. 2;

FIG. 4 is a side elevational view of the clamp shown in FIG. 2, the view being taken generally along the line 4--4 of FIG. 2;

FIG. 5 is an end elevational view of the clamp shown in FIG. 2, the view being taken generally along the line 5--5 in FIG. 2;

FIG. 6 is a plan view of the clamp shown in FIG. 1, certain parts being shown as removed or in section for the sake of clarity in the drawings and showing the position of the guide means for the initial drilling;

FIG. 7 is a view similar to FIG. 6, but showing the position of the guide means in the position for the counter drilling process;

FIG. 8 is a view similar to FIGS. 6 and 7, but showing the guide means when positioned so as to properly locate the screw which will hold the body bones or bone-like members together;

FIG. 9 is a perspective view of parts of a human shoulder before injury;

FIG. 10 is a view similar to FIG. 9 but showing the ruptured ligaments and the dislocated clavicle;;

FIG. 11 is a fragmentary plan view showing the bones that are to be fastened together in phantom lines and showing the clamp provided by the present invention in place and holding the parts firmly together;

FIG. 12 is a view of the parts shown in FIG. 11, the view being taken generally from the line 12--12 in FIG. 11;

FIG. 13 is a view similar to FIG. 12, but showing the clamp removed and the screw in place and holding the body parts together; and

FIG. 14 is a view taken generally along the lines 14--14 in FIG. 13.

DESCRIPTION OF A PREFERRED EMBODIMENT

The clamp C provided by the present invention includes a first member 1 having an elongated threaded portion of generally square cross section, the threads 3 being located only in the corners of the portion 2, that is to say a full thread is not formed in the portion 2. The first member 1 also includes a lower or inner, generally V-shaped portion 5 which terminates in a rather sharp end 6 and has a lowermost portion 7 which acts to guidingly receive one of the bones. The first member 1 also includes an off-set portion 11 which connects the portion 2 with the innermost, V-shaped portion 5.

The clamp also includes an outer member 13 which is generally flat and of considerable thickness. Member 13 has non-circular or square holes 14 and 15 extending therethrough and of a size and shape that complements the portion 2 of clamp member 1. Thus, member 13 can be inserted on portion 2 in the square hole 15 in the position shown in FIG. 1. With the member 13 positioned on member 1 as indicated in FIG. 1, member 13 cannot turn in respect to member 1 and consequently extends generally over the V-shaped portion 5 of member 1. It will be appreciated that arrangement of the parts of the body are different for the two sides, but with the two holes 14 and 15 in member 13, the member 13 can be used for an operation on either the left or right side of the body, which a right hand member, as shown, or reversely extending portions 11 and 5 that would constitute a left side clamp.

Assume that the operation is to be performed on the right side of the body, and the drawings have been shown to illustrate such a situation.

The term "bones" will be used to describe the present invention but it should be recognized that other bone-like growth, such as for example, a bony process referred to as coracoid, can be accomplished with the present invention.

The bones to be secured together, which will be referred to hereinafter in detail, are thus clamped between members 1 and 2, and a threaded thumb nut 17 is threaded on portion 2 of member 1 and can be tightened to bear against member 13 to thereby clamp members 1 and 13 against the bones located therebetween. Bone engaging projections 18 prevent clamp movement.

Member 13 has a rectangular slot 20 formed therethrough, the slot also having guideways 21 and 22 (FIG. 3) formed along the sides thereof. A first drill guide member 24 is located in the slot 20 and has corresponding guide members 27 and 28 which complement guideways 21 and 22 and are slidably mounted therein. Thus, guide member 24 can be slid in the opening 20 between a non-operative position shown in FIGS. 1 and 7 and an operative position shown in FIG. 6 where it is aligned with the lowermost V-shaped portion 7. Another drill guide member 30 is formed similarly to member 24 and is slidingly guided in the slot 20 between an inoperative position shown in FIGS. 1 and 8 and the operative position shown in FIG. 7. When the guides 24 and 30 are in the operative position shown in FIG. 8, the central portion of the slot 20 is open so as to guidingly receive the screw S which will hold the bones together. It will be noted that the central portion of the guide slot 20 of member 13 is located directly above the lowermost or V-shaped portion 7 of clamp member 1.

The present invention finds particular utility when repairing the human shoulder area and the invention will be described in connection with such operation, but is not necessarily limited thereto.

FIG. 9 illustrates an uninjured shoulder in which ligaments 43 hold the clavicle 44 (collar bone) to the scapula (shoulder blade) 40 including the bony growth that extends from the scapula and which is known as the coracoid process 42. The spine of the scapula terminates in the acromion 41. In injuries to the shoulder, as shown in FIG. 10, these coraco-acrominal ligaments 43 are torn and it is necessary to anchor the coracoid process 42 to other bone structure such as the clavicle 44, while healing of the injury takes place.

It should be recognized that the entire area surrounding these bones is covered or obstructed by nerves, tissue, muscles or other parts, and consequently, visual observation and handling of the bones is difficult.

The clamp provided by the present invention enables the surgeon to perform this operation with a minimum of "opening up" of the patient and enables him to properly locate the coracoid with respect to the clavicle and hold those parts in proper relationship while the drilling and fastening of the screw through the parts is accomplished.

More specifically, after opening up the area, the surgeon will use a scalpel or other instrument to cut through the necessary tissue, etc. under the coracoid and then the sharp end 6 of clamp portion 5 is inserted into the cut area and under the coracoid. The coracoid is then centered or guided into the V-shaped lowermost portion 7 of the clamp member 1. The surgeon then properly reduces or orientates the clavicle with respect to the scapula and its coracoid and after the parts are in proper relationship, he will then insert the member 13 of the clamp over the threaded portion 2 until it firmly engages the upper part of the clavicle. The thumb nut 17 is then screwed down firmly so as to hold the bones in clamped relationship. The bone engaging, sharp projections 18 prevent twisting of the assembled clamp relative to the bones. During this process, the surgeon is unable to clearly see the parts he is working on and the coracoid must be accurately centered in the clamp.

A hole must then be drilled through the bones which will ultimately receive a fastening screw, care being taken not to permit the drill to penetrate through the lower bone, namely the coracoid, so as to injure the nerves, vessels, muscles or other tissue indicated generally at 47 in FIG. 14. It is also essential that the hole being drilled is located centrally through the coracoid which is generally circular in cross section. Obviously, it is undesirable to drill a hole or portion thereof which cannot be used because it is misplaced or drilled at an improper angle.

After the clamp has been inserted in place and tightened to securely hold the bones together, the drill guide member 24 is slid to the central, operative position so that its relatively small hole 24a is located precisely in alignment with the bones and with the curved portion 7 of the member 1. The surgeon then drills a hole through the clavicle and coracoid. The portion 7 of the clamp can act to stop the drill and prevent it from going entirely through the coracoid. After withdrawing the drill, the surgeon slides member 24 to the inoperative position shown in FIG. 1 and the slides the second drill guide member 30, having a larger hole 30a into the central position. With the larger drill, the surgeon can form a counterbore 48 through the upper bone 44 only.

The screw is inserted through the central portion of the slot 20, when the guides 24 and 30 are slid to their inoperative positions, (FIG. 1) and thus the central portion of the slot accurately locates the screw in respect to the previously drilled holes.

The counterbore 48 permits the screw 50 to be inserted freely through the clavicle without threadably engaging it, and the threaded portion 50a of the screw threadably engages the smaller hole 52 in the coracoid. Tightening of the screw by the surgeon then firmly secures the bones together.

After the screw is firmly in place, the surgeon loosens the thumb nut 17 and removes it from portion 2 of the clamp, lifts clamp portion 13 outwardly off the portion 2 of clamp member 1, and removes the clamp member 1 from the patient.

The clamp provided by the present invention insures accurate positioning of the bones relative to one another and holds them in that position while the guide means insures proper drilling of and fastening of the screw in the bone members.

* * * * *

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