US2520035A - Metacarpal splint - Google Patents

Description

Aug. 22, 1950 D. GOLDBERG 2,520,035

METACARPAL SPLINT Filed May 20, 1948 2 Sheets-Sheet 1 Aug. 22, 1950 D. GOLDBERG 2,520,035

METACARPAL SPLIN'I Filed May 20, 1948 2 Sheets-Sheet 2 Patented Aug. 22, 1950 METACARPAL SPLINT David Goldberg, Springfield, Mass.

Application May 20, 1948, Serial No. 28,08?

3 Claims.

My invention relates to improvements in adjustable splints and is directed more specifically to the provision of an apparatus to be utilized for the retention of fractured metacarpal bones in a fixed position after reduction of the fracture.

It is a principal object of my invention to proviole an apparatus for the treatment of all types of fractures involving the last four metacarpal bones.

It is another object of my invention to provide a simple and inexpensive device to effect the immobilization and maintenance of anatomical restoration of position of a reduced fracture.

A still further object of my invention is to provide an instrument of the class above described which anatomically and physiologically answers the purpose of both the surgeon and the general practitioner.

Deformities of the hand often occur as the result of improper immobilization of a fractured metacarpal once it is reduced. These fractures are characteristically found among young or middle-aged men as they are usually the result of pugilistic encounters, or close hand to hand combat with the enemy in time of war. They may also be caused by a direct fall or an indirect trauma such as being struck by an object, shell fragment, bullet or the like.

The neck of a metacarpal, same being the smallest and weakest portion of the bone, is the most common site of the fracture. The fracture is more frequently transverse in character. The resulting deformity is that of a depression of the head with dorsal angulation of the fragments; The more dorsal the striking force against the head, the greater the depression of the knuckle. The more direct the force on the head in the longitudinal axis of the metacarpal, the greater the degree of impaction. A tangential striking force results in a depression of the head with impaction and angulation of the fragments.

Normally the interosseous and lumbrical muscles insert into a loose aponeurotic sleeve over the dorsum of the proximal phalanx just distal to the metacarpo-phalangeal joint. Contracture of these two muscles results in flexion of the metacarpo-phalangeal joint.

Following a fracture of the metacarpal, with depression of the metacarpal head, the directional pull of these muscles is altered and the proximal phalanx is pulled into hyperextension. The greater the fiexion deformity of the metacarpal, the more will be the hyperextension pull of the lumbrical and interosseous muscles, the shorter will be the relative length of the flexor 2 profundus and sublimis tendons, and the greater will be the flexion deformity of the interphalangeal joints.

This deformity in the laborer interferes with his grasp of an implement, The inability to flex the affected finger completely, results in weakness of the fiexion power of the adjacent fingers. The prominent head of the metacarpal in the palm of the hand may cause pain when an object such as a tool is grasped. The depression of the knuckle,

the prominence on'the dorsum of the hand, the hyperextension at the metacarpo-phalangeal joint and the fiexion deformity at the interphalangeal joints are cosmetically objectionable to women.

A ball or roll of gauze in the palm of the hand does not counteract but rather emphasizes the angulating pull of the lumbrical and interosseous muscles thereby increasing the deformity. Skeletal traction of any form or skeletal fixation introduces the danger of infection. When plaster is used, it is too difiicult to determine the exact amount of pressure necessary to maintain the position of the fragments. Too much pressure will result in pressure sores during the swelling stage which ensues within a few hours following the reduction. Too little pressure will result in reangulation when the swelling subsides. Constant immobilization of the flexed proximal interphalangeal joint, as advocated by J ahss, for a period sufficient to see callous on the X-ray film, often results in a fiexion deformity.

The instrument to be described is devised for all types of fractures involving the lateral four metacarpal bones. This includes all types of simple and compound fractures.

With the fracture once reduced, the operator will find that very little upward pressure on the head of a metacarpal and downward pressure over the distal end of the proximal fragment is necessary to maintain the corrected position. However, an upward force cannot be made at this time on the plantar surface of the metacarpal head, since pressure of any consequence on the intervening flexor tendon sheath would irritate its membrane and result in thickening and adhesions. In order to eliminate pressure over the fiexor tendon sheath, themetacarpo-phalangeal and first interphalangeal joints are fiexed to form right angles. proximal phalanx beneath the head of the metacarpal. Very slight pressure exerted upwards against the head of the flexed proximal phalanx results in elevation of the metacarpal head and easily maintains the corrected position of the This places the base of the fragments. The amount of pressure necessary is merely the equivalent of overcoming the angulation deformity caused by the pull of the interosseous and lumbrical muscles.

These fractures were originally treated with a metal splint, using the flexed finger throughout the entire period of immobilization. At that time it was necessary to see the patient every second or third day in order to extend the proximal interphalangeal: joint and thus avoid a fiexion contracture. An attempt was then made to eliminate the necessity of seeing the patient so frequently.

After the first three to five days, the swelling of the soft tissues and the spasm of the traumatized interosseous and lumbrical muscles hassubsided. Therefore it was felt that slight amount of upward pressure on the ventral surface of the metacarpal head at this time would not irritate the flexor tendon sheath. A square attachment, which will bev described, was then devised; which. applied the upward pressure directly beneath the metacarpal head. This proved; to be veryv satisfactory. but one difficulty was encountered. The splint, being constructed of metal, obstructed adequate visualization of the fragments on the. rentgenogram. Hence, on subsequent cases, the splint was, constructed of a. plastic material, and. proved more satisfactory since. it was radiolucent.

An attempt was then made to combine. both instruments into .onein order tosimplifyreplacement of thevertical. arm with the. square attachment. simple attaching means which is adapted for; securement to both. the. vertical and the square attachment as will presently. be. observed;

Attention. is. directed toan earlier patent $2,357,323, issued to.me.on. September 5, 1944, whereinwas disclosed by measimple and. inex.-. pensive-device designed toeffect the immobiliza-. tionand maintenance of anatomicalrestoration ofa reduced fracture. In this patent, I. disclosed an apparatus forthe treatment. of simple. trans.-. verse andimpacted.fractures'of thelateral four. metacarpal. bones. which employed theprinciple. of pressurepads to maintaintheposition of the. fragments after-closed. reduction and could be. easilyapplied andadjusted without fear of pres: sure. sores, infection, loss of: position, or deformities.

With the foregoing. and. various other novel. features and advantages and other. objects of. my invention aswill becomemore. apparent as the description proceeds, the. invention. consists. in. certain novel features of construction andin the combination and. arrangement. of; parts. as will be, hereinafter more. particularly pointed out in the claims hereunto annexed and more fully describedand referredto in connection with the accompanying drawings wherein:

Fig. 1 is atop planview of; one of the ar-. rangements of my. invention;

Fig. 2 is.a.side-elevationa1 view. of the device shownin Fig, 1;

Fig. 3 is atop plan view of.another of the ar-. rangements of the apparatus. of. my. invention;

Fig. 4 isa sideelevational view of. thedevice. showninFig. 3;

Fig. 5 is. av sectionalview. through oneof. the.

pressure. bodies. of. my. invention;

Fig 6:.is aperspective view showing one ofthe arrangements. of my. invention in cooperation,

with apatienflshand; and.

Fig. '7 is. a perspective .view: showing the-other.

l his. is accomplished by. using. a.

of the arrangements of my invention in cooperation with a patients hand.

Referring now to the drawings more in detail in which similar characters of reference indicate corresponding parts in all the views, my invention will now be fully described.

An elongated rigid bar member is generally designated by I 0 and is formed of a plastic or other suitable material.

Preferably the member It, as Well-21S all other components of the invention which will be described, with the exception of the soft pad members, are made of plastic. With the employment of metal; adequate visualization on the roentgenograrn is obstructed. Plastic, being radiolucen-t, is muchmore satisfactory.

'I-Thernemben I ll has at one end a straight distal or metacarpal portion l2 and has at the other end a forearm supporting portion [4.

The plane of the forearm supporting portion i4 is offset relative to the plane. of the. metacarpal portion. l2 substantially asshownin Figs. 2 and 4 and the portions areconnectedby. a. wrist orcar pal: portion I 3. The wrist portion. is. angularlydisposede relative tothe distal portion l2 and the forearm portion I4 soas to form. an angle of apprQXimatelylSO-degrees with-the-metacarpal portion. 12: and an-angleof approximately 210degrees with the forearm portion I4.

The member- In is of such configuration as to overlie conveniently the hand, wrist and arm of the patient, all fon purposes as will shortly be understood.

The metacarpal portion I2'of the member 1 Dis provided with a longitudinallyextending slot l6 intermediate its ends for the reception of a screw [8 which may be heldrigidly in, any desired fixed position within the slot' l6 by the locking action of a pair of nuts 20 and 22, the nut 20 being threaded upon the screw upwardly of he membe an he t e n threaded upon the screw downwardly of the member. ID; whereby the nuts 2 0 and 22 may be adjusted relative to each other so as to embrace the member IQ inany desired relation A pressure body. is provided and, comprises the screw l8 which has a ball member. Hat its lower extremity, same. being freely receivable in an enlarged, socket 26 centrally disposed. in. one side of. a pressureplate 2 8 The memberv 28.is covered. by a cap,member 30, which. is secured thereto and haseanopening therethrough whichv is; of lessidimension than the. socket 26-, in the member 28 and which receives the screwl8- therethroughso as to; produce a loose jointed. lat n ip; tw nthe w; 8 a p sur rla e 2 am a h wn n Efixedtothe opposite sideof the plate 28 is apad or; shion m mb r. 3k hi co ta ts he. uppersurface of the patientFshandWhen in use. emembe 3!: maybe madezo an t ilient material suchas-rubben or the like.

The pressure body may be horizontally adjustedrelative-tothe member ID by the sliding e: w. I 8 a on and; th n e. o i de I nal slot I6 and maybe vertically adjusted; by, means of; the; relative positioning of the nuts 2 0 and;2 2;on the Screw, l8-, all to theend that the. desiredpressure of the pad: 34: upon the upper surface of the hand may; be, pril'nar-ily; located; andsecondarily regulated relative theretoallfor purposes presently to be described;

The. forearm supporting: portion lfliis provided with. a; plurality. of: projections; or studs: 40'; ex,

tending upwardly from the upper surface thereof. i

When the device is in use, as a plaster of Paris bandage is wrapped around the combined bar member I and the distal portion of the forearm of the patient, the studs 40 are engaged thereby so as to prevent slippage of the member ID relative to the hand, wrist, and forearm and to retain the same in the desired fixed position. Greater binding area for the plaster of Paris bandage is afforded by the provision of the studs 40 as may be seen and appreciated by reference to Figs. 6 and '7.

' An elongated vertical finger supporting or phalangeal member 50 is provided and consists of a rigid bar member having a longitudinally extending slot 52 intermediate its ends.

The upper end portion of the member 50 is provided with a leg 54 extending angularly from the main body portion of the member 50 and said leg is provided with a centrally disposed opening therethrough for the reception of a screw 58 having a head 6E] and threadedly engageable with a nut 62.

The phalangeal member 50 is adapted to be fixed rigidly to and generaly at right angles to the member II] by means of the screw 58, receivable not only through the opening 56 of the leg 54 butalso through the longitudinal slot I6 of the metacarpal portion i2, which screw 58 is held in any desired position by the tightening of the nut 62 in threaded engagement therewith.

An advantage in the arrangement of the members I0 and 58 as separate components is that one may be pivoted relative to the other so as to suit better each patients individual requirements as will presently be observed to be so desirous. That is to say, the members H3 and 53 may be held in positions angularly disposed as to each other as for example may be observed in Figs. 1 and 2. This arrangement helps to compensate for the variations in the differing sizes and shapes of hands of different people and thus aids better approximation of the phalangeal of the fractured metacarpal in each individual case.

The longitudinal slot 52 of the phalangeal member 50 provides for the attachment of an adjustable bracket generally designated by 10.

The bracket is composed of a base member I2 slidably engageable with the member 50 by means of a bolt or threaded projection I4 whereby the member may be rigidly retained in any desired position relative to the member 50 within the limits of the longitudinal slot 52, all by tightening a nut I6 threadedly engageable with the member 14.

' The upper surface I8 of the bracket I0 is provided with a centrally disposed opening therethrough for the reception of a bolt or threaded projection 80 extending downwardly from a supporting plate member 82.

The member 82 is disposed upon the upper surface I8 of the bracket III and is held relative thereto by means of the bolt 80 and a nut 84 threadedly engageable therewith.

Upon the upper surface of the supporting plate member 82 is mounted a pad or cushion member 86 which may be made of a soft yielding material such as felt, rubber, or the like so as to offer a soft contacting surface for the fingers of the patient for reasons as will shortly be observed.

The position of the bracket I0 relative to the phalangeal member 50 and the position of the plate member 82 relative to the bracket 10 may be adjusted by the separate means heretofore explained so that the finger or fingers of the patient may rest comfortably upon the pad member 86. I I

The members82 and 86 may, if desired, be-of greater length than width and may be disposed relative to the fingers so as to accommodate more than one finger thereon as shown in Fig. 6.

The vertical member is used usually for the first three to five days of treatment of the simple but complex type of metacarpal fractures and may be quickly and conveniently detached from the member ID as will presently be observed.

A square supporting member generally indicated by I00 is also provided and comprises a rectangular shaped bar member having an upper bar I02, 3. lower bar I04, and a pair of sidebars I06 and I06.

The member I00 may be substituted for the member 5!] when it is desired by the operator to continue immobilization of the fragments yet to alter the position of the finger or phalangeal portion from the fiexion to the extended and free position.

The upper and lower bars I02 and I 04 respectively are provided with longitudinally extending slots I08 and H0 respectively intermediate their ends.

The screw 58 having the head 60 formerly associated with the member 50 is receivable through the slot I08 of the upper bar I02 and also through the slot I 6 of the member ID, and is adapted to hold the members II} and I00 in any desired position relative to each other by means of the nut 62 threadedly engageable therewith.

Thus it will be observed that the bar member ID and the square member It!) may be rigidly held in various positions relative to each other and relative to the arm and hand of the patient to suit the particular needs of each individual case.

The member I00 may be pivoted relative to member In so that one is angularly disposed rel- Y ative to the other. This feature is especially desirable when the patient puts on or takes off a piece of clothing which has to be slipped on over the arm as in the case of a sleeve of a coat. By a slight angular adjustment of the member I00, the operation may be performed with ease.

Similarly as shown in the case of the pressure body shown in Fig. 5, a supporting body is provided and comprises a screw H8 which has a ball member at its upper extremity, same being freely receivable in an enlarged socket of a supporting plate I26, which member has a cap member (not shown) secured thereto and has a centrally disposed opening therein for receiving the ball of the screw II8 therethrough so as to produce the same adjustable and loose jointed relationship between the screw H8 and the supporting plate I28 as between the members I8 and 28 in Fig. 5. This is essential in order to allow for slight variations in the size and shape of the hand and to maintain at the same time an even distribution of force throughout the entire contact surface.

Fixed to the upper side of the plate I26 is a pad or cushion member I34 which contacts the palmar surface of the patients hand at the metacarpal head. The member I34 may be made of any soft yielding material such as felt or the like.

The screw II8 may be held rigidly in any desired position horizontally along the slot III] by the locking action of a pair of nuts I36 and I38,

the nut I36 being threaded upon the screw upweirdly-of, themember' H14 and. the. nut. I38. be-

ing: threaded: upon the screw-downwardly of the member [M all to. the: end that. the nuts 1-3.6 and I38 may be adjusted relative to each other so: as; to; embrace tightly: or loosely the member L04: as may be.-desired-.

The screw member H8; may, likewise, be: adjusted vertically ofthe: member I00 50* as to; be brought into and out: of: engagement with the patients hand, allasdesired.

The member 100 isused during thelater periodof treatment in some; simple fractures, or during, the: entire course; of treatment: in: simple orcompound fractures. of the.- metacarpal.

Another advantage inthe. arrangement of. members; [0' and' 50 as separate components is injuries, malunited fractures following open operation and bone grafting, and also following operative intervention for ununitedfractures of any portion of the laterala four metacarpal bones ofeither. hand.

Modifications of thedevice such as increasing the width or length of the. pressure plates 28, 82- and l-26- for use: in cases where more than; one

metacarpal bone is fractured may be made with. out departing from the scope andv spirit ofthe;

invention.

The; invention may be embodiedin other. specific forms without departing: fromthe essential Hence, the. present emcharacteristics. thereof. bodiments are therefore to be considered inall.

respects merely as being illustrative and not. as-

beingrestr-ictive, the scope. of the invention being: indicated by-the appendedclaims rather than bythe foregoing description, and all modification.

and variations as fall withinthe meaning. and

purviewand range. of equivalency of the ap-'- pended claimsare therefore intended to be embraced therein.

What it is desired. to=claim and-secure by LetterslPatent of the United States is:

1-..An adjustable splint for use in maintaining afractured metacarpal bone in anatomicalalignment after-reduction comprising in combination, an elongatedbar member having a. meta carpal. portion and a forearmportion at itsop posite ends'ancta carpal por-tionintermediate itsends, a vertically extending phalangeal mem-' ber pivotally securable tov one end of said bar.-

member, an adjustable pressure-body depending? downwardly in slidable relationship from; saidbar member and-adaptedto be adjusted-seas to pressagainstthedorsal surface" of a patients hand proximaltothe fracture: site, an adjustable supportmember in perpendicularly disposed-slidable relationship-with said. phalangeal memberfor movement into and out of a-positionof supportf or. the second row. phalanx associated with the: fractured metacarpal, and: asquare member: depending downwardly of and pivotally securableto: said bar member and having an adjustable cushionedsupportingplate member for upward pressure. against the pahnar' surface of apatients; hand.

2-. An adjustablezsplint for use in maintaining; fractured metacarpal bonesin anatomical alignment after reductionv comprising incombination, azframe. memberfor securement. to the forearm'of the.- patient, a .pivotable verticaliphalangeal member depending; from the forward end ofsaid frame member, an adjustable pressure body depending; downwardly: fromv said framemember and=adapted1tocontact the dorsal surface of the metacarpal regionof a. patients hand proximal to the fracture site, avertically and. angularly adjustable bracket member connected to said phalang eal member and adapted. toretain the fingers of the fractured metacarpals flexed into:

the palm of the hand, means associated with saidfreme member adapted to retain the device in afixedpositionrelative to a. plaster of Paris. cast, and a square member adapted for pivotalsecurement tosaid frame member and dependingdownwardly therefrom.

3; An adjustable splint for main maintaining. a fractured metacarpal bone in-anatomical align?- ment after reduction. comprising. in. combination,

a single elongated bar member having a metacarpal. portion and a' forearmsupporting portion at its. opposite ends, said bar member: having alongitudinal slot in the metacarpal portion there.- of, a pressure body having; anupstanding: supportingelementadjustably receivable in; the slot of said bar; member and a. pressure element. de-

pending'downwarclly therefrom-beneath;said: bar memberfor' exerting pressure. against; the dorsal surface of a patients handproximaltothe fracituresite, arr elongated'rectangular frame formed from opposite ancbadjacent'; longitudinal: and transverse. members; one: of: saidl longitudinal:

membershaving a longitudinal slotv intersecting? with. the longitudinal: slot said bar member,

locking means receivable at the intersection. of:

the slots of said bar-memberand the said one longitudinal member for adiustably' holding the same insecurement relative toeach other, and

an adjustable supporting plate memberpivotally secured to the other of said longitudinal membars for movement int'o-and out of a position of support for exerting upward pressure against the palmar surface of apatients hand.

DAVID GOLDBERG;

REFERENCE S. CITED The following references. are of record in th file of this patent:

UNITED STATES- PATENTS Number Namev Date 1,885,448 Jones Nov; 1,, 1932'. 2,357,323 Goldberg Sept. 5, 1944 OTHER'. REFERENCES Catalog of De Puy-Mfg. Co; of 'Warsaw; Indiana; copyrightedin- 1943;, page 18.:

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