US 2089993 A
Description (OCR text may contain errors)
Allg 17, 1937. v. cARABBA 2,089,993
FRAGTURE REDUCING APPARATUS Filed NOV. 13, 1935 2 Sheets-Sheet 1 INVENTOR.
4Z y, l l VICTORCARABBA ATTORNEY.
l i B Aug. 17, 1937. v. CARABBA 2,089,993
FRACTURE REDUCING APPARATUS Filed Nov. 15, 1935 2 Sheets-Sheet 2 VICTOR GAMMA INVENTOR.
Patented Aug. 17, 1937 NETE@ STATS einer 6 Claims.
The present invention relates to fracture reducing apparatuses and relates more specifically to an apparatus for the treatment of fractures of the os calcis.
The occurrence of the more serious fractures of the os calcis is relatively small compared to the fractures of other bones. The percentage of these fractures requiring radical surgical intervention, compared with fractures of the long bones, is also small. When however, the surgeon is confronted with a badly displaced simple or comminuted fracture of the os calcis, he is faced with a serious problem. Orthopedic surgeons frequently advise immediate arthrodesis, while others maintain the more conservative position of employing surgical means for effecting the reduction.
The principal object of the present invention is to provide a simple and inexpensive apparatus for the reducing of fractures of the os .calcis which is particularly efficacious in cases of badly comminuted and displaced fractures.
Another object of the invention is the provision of a device for the reduction of fractures of the os calcis which will reduce the pain and inconvenience of the patient to a minimum.
The use of the Steinman pin in the reduction of bone fractures is well known. This pin is split in the center and is provided with screwthreaded male and female meeting portions, the central portion of the piny being of larger diameter than the end portions thereof, which latter are tapered. The pin is driven through the fractured bone by the use of a hammer and after the reduction has been made, the pin is suitably secured at the ends thereof to maintain the reduction until the fractured portions have united. Up to the present time, however, no suitable apparatus has been devised which effectively permits the use of the pin in the reduction of fractures of the os calcis.
The present invention includes a frame which is secured at its opposite ends to a plaster cast boot which has been previously applied to the leg and foot, the heel portion of the foot not being covered with the plaster. A stirrup-like structure is pivotally carried on the frame and is capable of two adjustments to effect posterior and anterior reduction of the fracture. rIlhe first adjustment is the pivotal one, whereby the Steinman pin, which is secured to the ends of the stirrup, may be drawn forward to effect posterior reduction. The second adjustment is accomplished by providing means for lengthening and shortening the stirrup to effect anterior reiv., uU
(Cl. 12S-84) duction. Inasmuch as the frame is secured to the plaster rigid boot only, the reduction may be effectively performed without undue pressure on the bones or tissues.
In the drawings, Fig. l is a perspective View of the apparatus secured to a plaster cast boot which has been formed upon a patients foot;
2 is a side elevation of the device; and
Fig. 3 is a front elevation thereof in perspective.
The preferred embodiment of the invention includes a universal fitting central base bar l, made from a flat strip of metal, the bar having a curved portion Il at its lower end which fits into the concavity formed by a plaster boot i2 which has been applied to the foot and leg.
The terminals of the base bar are provided with transversely disposed curved plates i3 and i4 to which straps i5 and iii are secured, the strap l5 engaging the portion of the paster cast on the foot, and the strap i6 engaging the calf portion of the leg. A substantially U-shaped brace I8 is secured to the lower end of the base bar by means of screws I9, the brace and the base bar constituting the frame of the device.
The adjustable stirrup structure includes a pair of opposed, spaced-apart supporting members 2l having outwardly extending offset portions 22, the member being pivotally carried on a block 23, which is secured to the upper surface of the curved portion il of the base bar by means of screws 251, the pivotal element being designated as 25. A pair of L -shaped extensible members or stirrup arms 2l are carried on the offset portions 22 of the supporting member 2l in the following manner. The arms 2l are formed with longitudinal slots 29 through which a pair of spaced screws Sil pass into the lower ends of the offset portions 22. Thus, the extensible members may be moved longitudinally the full length of the slots 29. A pair of opposed angle brackets 32 are secured to the upper portions of the supporting members 2l by means of screws 36. A traction screw 35 having a thumb turn 36 is carried at the outer end of each of these angle brackets, the lower end of said screw passing through a threaded aperture 3l in the horizontal portion of the eXtensible member. Thus, as the thumb turn is rotated, each stirrup arm is caused to move independently upwardly or downwardly, as desired.
In actual practice, the arms of the stirrup are so constructed as to be possible of elongation of a distance of five centimeters or thereabouts. The lower ends of the stirrup arms are provided with extension members 39 which carry opposedV clamping members 4i, which are Vadapted to rmly support the Steinman pin (not shown) by tightening the thumb turn ft2.
5 VRotation of the `stirrup structure is accomplished in the following'manner. A bracket i4 is secured to the U-shaped brace i8 by means of the screw IS. A traction screw IE5, having a thumb turn 46, is carried on Vthe outer end oi 10 this bracket, the forward end orV the traction screw passing through a block fii, which pivotally carried between the upper terminals of the supporting .members 2i by means of -screwsV 119. As this thumb turn is rotated, the stirrup strucl5 ture is movable through an arc of approximately The operation of the device is as follows: The patient is irst given a spinal anaesthesia and, under sterile precautions, a Steinman pin approXimately six inches in length is passed through the os calcis ata point one or two centimeters below the vattaclnnent of the tendoachilles. A sterile dressing is now applied to the points of entrance and exit and the Steinman pin and the operative wound through which the tenotomy has been performed. A plaster boot i2 is next applied to the foot and the lower portion of the leg with the foot at right angles and internal rotation, the heel portion of the foot not being covered by the cast. In Fig. l the heel portion is shown with a gauze dressing 48. Y
This fixation ofY the foot allows any traction applied to the os calcis to act on that bone without movement of any other portion of the foot "5 or ankle. -When the plaster boot is thoroughly hardened and dried, the apparatus is strapped onto the foot and leg, as shown in Fig. l. In most instances, the stirrup arms are fully lengthened and are revolved backwardly to the position shown in broken lines in Fig. 2, prior to the application of the device to the plaster boot, the device then being secured in such a position as to cause the clamping members il to be adjacent to the terminals of the Steinman pin when the stirrup is so lengthened and revolved, since the reduction of the fracture normally requires aV considerable shortening ozf the stirrup and a revolution thereof to the position shown in full' Vlines in Fig. 2. The terminals of the Steinman pin are now secured between the portions of the vclamping members and a cork 5B placed at each end of thepin to prevent the same from injuring the patients other foot, and also the tearing of bed linen.
The screws 35 are now operated to lengthen the stirrup arms backward. Thislengthening is continued until all impaction is broken up and the widening of the body of the os calcis is preperly reduced to normal. The screw i5 is next operated to rotate the stirrup arms forward,
which rotatesthe bone fragments downward and forward. This movement represents the exact opposite force which caused the'fracture in the rst instance. In the event tilting of fragments has occurred to one side o-r the other, simple overlengthening of one of the stirrup arms will-tilt the pin to correct the tilting fragments. An X-ray is rimmediately taken and further adjustments made until the fragments are vin perfect alinement. Y
After the reductionhas been completed, the
apparatus may be removed and the plaster boot completed to incorporatethe Steinman pin in the exact position ofreductcn'by the apparatus, the l shifting the bifurcated element and for revolving same through an arc, and means adjacent to the terminals of the bifurcated element for receiving an elongated pin.
2. In a fracture reducing apparatus, the combination of a frame, fastening means disposed at opposite ends of the frame for securing the same to the foot and leg of a patient, a stirrup structure pivotally carried on the frame, a pair of independently movable, shiftable arms carried by the stirrup structure, clamping means positioned at the outer terminals of said arms,fscrew means for shifting said arms and screw means for moving the stirrup structure through an arc.
3. An apparatus for reducing fractures of the os calcis including, in combination, an elongated base member having a curved forward portion adapted to engage the foot of a patient, strap means disposed adjacent to opposite ends of the frame for securing same to the foot and leg of the patient, a shiftable bifurcated clamping element pivotally carried on the Abase member, and traction means for independently,shifting the terminals of the clamping element and traction means for revolving said terminals through an arc.
4. In an appartus for reducing fractures of the os calcis, the combination of a frame having a curved portion adapted to fit the ankle portion of the patient, means for securing the frame to the leg, a stirrup structure pivotally carried en the frame, a pair of extensible arms carried by the stirrup structure, clamping means positioned Cil at the outerterminals of said arms for securing the terminals of an elongated pin, screw means for lengthening and shortening said arms and screw means for revolving the stirrup Ystructure through an arc. Y
5. In an apparatus for reducing fractures of the os calcis, the combination of an elongated base member shaped to fit the front leg and ankle portion of a plaster cast which has been formed on the patients leg and foot, an extensible bifurcated member pivotally carriedron the base member, clamping means at the lower end of the bifurcated member Yfor securing the terminals of a Steinman pin or the like, thumb turn actuated screw means for shortening and lengthening the bifurcated member and similar means ier revolving the member through an are.
6. In an apparatus for reducing fractures of the os calcis, the combination'of a frame having 'a vcurved portion adapted to fit the ankle portion of theV patient, means for securing the frame to a plaster boot which has been. formed on the leg ofthe patient, a stirrup structure pivotally carried on the frame, a pair of vextensible arms carried by the stirrup structure, clamping means positioned at the outer terminals of said, arms f for securing the terminals of .an elongated pin adapted to be passed through the os calcis,rscrew means fer lengthening and shortening the extensible `arms independently of each other, and screw means for` revolving the stirrup structure through an arc.